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Tumors of the Ischiorectal Fossa

A Single-Institution Experience

Zhu, Katherine J., M.B.B.S., F.R.A.C.S.1; Lee, Peter J., M.B.B.S., M.Sc.(Med.), M.S., F.R.A.C.S1,2; Austin, Kirk K. S., B.Sc., M.B.B.S., B.A.O., A.F.R.C.S.I., F.R.A.C.S.1,2; Solomon, Michael J., M.B.B.C.H. (Hons), B.A.O., M.Sc., D.Med.Sc., D.Med., F.R.C.S.I., F.R.A.C.S., F.A.S.C.R.S.1–4

doi: 10.1097/DCR.0000000000001249
Original Contributions: Colorectal Cancer
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BACKGROUND: Ischiorectal fossa tumors are rare.

OBJECTIVE: This study reviews a single institution’s series of ischiorectal tumors with comparison against presacral tumors and assesses the utility of preoperative biopsy and angioembolization.

DESIGN: This is a retrospective study.

SETTINGS: This study was conducted at a quaternary referral center.

PATIENTS: All patients with ischiorectal tumor treated between February 1995 and April 2017 were retrospectively reviewed. Tumors extending secondarily into the ischiorectal fossa and inflammatory pathologies were excluded.

INTERVENTIONS: Preoperative biopsy, neoadjuvant therapy, angioembolization, and surgical excision of these tumors were reviewed.

MAIN OUTCOME MEASURES: Demographic, perioperative, pathological, and oncologic outcomes were evaluated.

RESULTS: Twenty-four patients (15 female; median age 54) were identified. Two-thirds were symptomatic. Forty-six percent had a palpable mass. All patients had CT and/or MRI. Fifty percent had a preoperative biopsy, of which 83% were diagnostic, and management was altered in 50%. All patients underwent surgical excision. Fifty-five percent had local excision, 38% had radical pelvic excision, and 8% had total mesorectal excision. Two patients had preoperative angioembolization. Both had successful R0 local excision. Morbidity occurred in 25%, with 1 major complication. There was no 30-day mortality. Histopathology demonstrated 17 soft tissue tumors (3 malignant), 2 GI stromal tumors, 1 neuroendocrine tumor, 1 Merkel cell carcinoma, 1 basaloid carcinoma, 1 epidermal cyst, and 1 lipoma. R0 resection was achieved in 75%. All patients were alive after a median follow-up of 33 months. Four patients developed recurrence at a median 10 months postoperatively. All recurrences were malignant, and 75% had had a R1 resection.

LIMITATIONS: This study is limited by its small numbers. The quaternary institution source may introduce bias.

CONCLUSIONS: Ischiorectal fossa tumors are heterogeneous and more likely to be malignant than presacral tumors. Biopsy can be useful if a malignant diagnosis is suspected and changes management in 50% of cases. Preoperative embolization may be useful for large vascular tumors. R0 resection is important to minimize recurrence. See Video Abstract at

1 Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District, University of Sydney, Sydney, Australia

2 Department of Colorectal Surgery, Royal Prince Alfred Hospital, Institute of Academic Surgery, Sydney, Australia

3 Central Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia

4 The Institute of Academic Surgery - RPA, Camperdown, Australia

Funding/Support: None reported.

Financial Disclosures: None reported.

Poster presentation at the American Society of Colon and Rectal Surgeons Meeting, Seattle, WA, June 10 to 14, 2017.

Correspondence: Michael Solomon, M.B.B.C.H. B.A.O.(Hons.), M.Sc., D.Med.Sc., L.R.C.P.I., F.R.A.C.S., F.R.C.S.I.(Hons.), Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, PO Box M157, Missenden Rd, NSW 2050, Australia. E-mail:

© 2019 The American Society of Colon and Rectal Surgeons