ISCHIORECTAL FOSSA TUMORS: A 30-YEAR SINGLE INSTITUTION EXPERIENCE
Thomas Peponis*1, William Perry1, Francisco M. Abarca Rendon1, Nicholas P. McKenna1, Asya Ofshteyn1, Scott Kelley2
1Colon and Rectal Surgery, Mayo Clinic Minnesota, Rochester, MN; 2Mayo Clinic Minnesota, Rochester, MN
Background: Primary tumors of the ischiorectal fossa are rare and comprise a wide array of pathologies with varying malignant potential. Due to the low prevalence of these tumors, there is a paucity of data in the literature. This represents a large series on patients diagnosed with primary tumors of the ischiorectal fossa, including preoperative workup, surgical approach, and long-term oncologic outcomes.
Methods: This was a retrospective study conducted at a tertiary referral academic healthcare system. All patients older than 18, who underwent surgery from 1992 to 2022 for a primary tumor of the ischiorectal fossa, were included in the study. Patients who had metastatic disease in the ischiorectal fossa, or patients with tumors originating from adjacent organs that were invading the ischiorectal fossa were excluded from the analysis. The primary outcomes of the study were disease recurrence and overall survival.
Results: A total of 34 patients were identified, 53% of which were female. The median age was 52.5. Seventy-five per cent of patients were symptomatic and had a palpable mass on presentation. Nearly all were managed in a multidisciplinary fashion and had a preoperative biopsy for tissue diagnosis. Twenty-six patients (77%) underwent a wide local excision, six (18%) had a radical resection including a total mesorectal excision, and the remaining two were managed with a pelvic exenteration and a hemipelvectomy. Twenty-one patients (62%) were diagnosed with benign and 13 (38%) with malignant tumors. The most common benign diagnosis was aggressive angiomyxoma in seven patients and the most common malignant pathologies were leiomyosarcoma in three and solitary fibrous tumor in another three patients. The median tumor size was 8.4 cm. Ninety per cent of patients had an R0 resection and no one had an R2 resection. Twelve patients developed a recurrence with a median time to recurrence of 6.5 months, seven of which were locoregional. In 9 patients, the recurrence followed an R0 resection. The median follow up was 23 months. Only 3 patients, all of whom were diagnosed with metastatic disease, died at 6, 21, and 66 months post-operatively.
Conclusion: Ischiorectal fossa tumors are primarily benign, however they are associated with high recurrence rates even in the setting of an R0 resection. Despite the high recurrence rates, overall survival rates are good.
Back to 2023 Posters