Transsacrococcygeal approach in rectal gastrointestinal stromal tumour resection: 10-year experience at a single centre

Background: The transsacrococcygeal (TSC) approach in rectal gastrointestinal stromal tumour (GIST) resection is clinically challenging and controversial, and we evaluated its value in the present study. Methods: We enrolled patients who underwent rectal GIST resection by the TSC approach during 2008- 2018. The clinicopathological index, surgical outcome, and prognosis were analysed. Prognostic information was obtained from medical records and follow-up data. Anal function was evaluated by the low anterior resection syndrome (LARS) score. Results: Among 88 rectal GIST patients over the 10-year study period, 17 who underwent the TSC approach were analysed. The median age was 55 (range, 26-73) years. In total, 15 patients received preoperative imatinib neoadjuvant therapy for 232 (30-690) days. The tumours were exogenous in 14 patients and intramural in 3 patients. The mean initial tumour size and preoperative tumour size were 6.4 +/- 2.2 and 4.2 +/- 1.7 cm, respectively. The operative time and blood loss were 130.2 +/- 47.4 min and 44.6 +/- 36.0 mL, respectively. Of the 17 patients 7 had postoperative complications (within 30 days postoperatively), and the complications of 5 patients were cured by conservative treatment. Only 1 patient was lost to follow-up, and the others had a good oncological prognosis at recent follow-up evaluations. All patients had LARS scores <= 9 points at 1 year after the operation. Conclusions: The TSC approach can result in a good oncological prognosis, usually does not affect anal function, and is particularly suitable for exogenous middle and low rectal GISTs. However, it might cause some controlled complications. Hence, careful patient selection is necessary for this operation.