Abstract
BACKGROUND: Retrorectal tumors are rare, heterogeneous neoplasms in the pararectal space that have low incidence, nonspecific symptoms, and variable presentations; they are often challenging to diagnose and manage, necessitating high clinical suspicion. We evaluated the clinical characteristics, diagnostic challenges, surgical outcomes, and postoperative follow-up of patients with retrorectal tumors treated over 12 years. METHODS: A retrospective case series was conducted on 34 patients who underwent surgery for retrorectal tumors at Taleghani Hospital, Tehran, Iran, from 2011 to 2023. Clinical presentations, imaging findings, surgical interventions, histopathological diagnoses, and postoperative outcomes were analyzed. RESULTS: Thirty-four patients with 37 lesions were included, with a mean age of 40.21 ± 11.57 years. The majority of patients were female (88.2%). Pelvic pain was the most common symptom (44.1%), followed by rectal pain (38.2%). The retrorectal space was the most frequently affected location (67.6%). Most tumors were cystic (51.4%), with congenital tumors being the most common histopathological subtype (37.8%). Malignancy was identified in 29.7% of cases. The most frequent surgical approach was total resection via the posterior approach (55.9%), followed by the anterior approach (26.5%). Postoperative recurrence requiring secondary surgery was observed in 5.9% of patients. CONCLUSION: Due to their rarity and diverse presentations, retrorectal tumors pose significant diagnostic and surgical challenges. Preoperative imaging plays a critical role in diagnosis and surgical planning. Complete surgical excision remains the mainstay of treatment, and recurrence is rare. Multidisciplinary collaboration is essential for optimizing patient outcomes.