Presacral tumours: international consensus on diagnosis and management

Perry, WRG; Dozois, EJ; Brown, KGM; Burns, E; Denost, Q; Frizelle, F; Glover, TE; Glyn, T; Graham, RP; Heriot, A; Merchea, A; Quyn, A; Sagar, P; Solomon, MJ; Thomas, G; Tiernan, JP; Turner, GA; Warrier, S; Wood, V; Presacral Tumour Working Group; Jenkins, JT

Author(s): Perry, WRG; Dozois, EJ; Brown, KGM; Burns, E; Denost, Q; Frizelle, F; Glover, TE; Glyn, T; Graham, RP; Heriot, A; Merchea, A; Quyn, A; Sagar, P; Solomon, MJ; Thomas, G; Tiernan, JP; Turner, GA; Warrier, S; Wood, V; Presacral Tumour Working Group; Jenkins, JT;
Details: Publication Year 2026-05-07,Volume 113,Issue #5,Page znag053
Journal Title: British Journal of Surgery
Publication Type: Guideline
Abstract: BACKGROUND: Presacral tumours are rare and heterogeneous lesions arising within a complex anatomical space, resulting in variability in diagnosis and management. Increasing incidental detection and evolving surgical and oncological strategies have highlighted the need for contemporary guidance. The aim of this study was to establish an international expert consensus on the optimal diagnosis and management of presacral tumours. METHODS: An international panel of colorectal surgeons from high-volume units was convened. Evidence- and practice-based statements were developed after domain-based literature reviews and refined through five online and two in-person meetings. Consensus was achieved using a modified Delphi process with anonymous voting. RESULTS: In total, 16 colorectal surgeons participated in the study. Ten domains were identified resulting in the development of 22 statements based on expert opinion and retrospective studies. After two rounds, unanimous (100%) agreement was achieved for all statements. High-resolution MRI with structured synoptic reporting is endorsed as central to risk stratification. Selective image-guided transperineal or parasacral biopsy is recommended for high-risk lesions where histology would alter management. Complete surgical resection is defined as the operative goal, with approach tailored to tumour biology and anatomy; minimally invasive surgery is considered appropriate in selected cases. Non-operative surveillance is supported for carefully selected asymptomatic, low-risk cystic lesions. Postoperative surveillance is recommended in a risk-adapted manner according to histopathology and margin status. CONCLUSION: This international consensus provides a pragmatic, risk-stratified framework for the multidisciplinary diagnosis and management of presacral tumours. These recommendations aim to reduce practice variation, support decision-making in specialized centres, and inform future prospective collaborative research.
Publisher: Oxford University Press
Keywords: Humans; Consensus; Delphi Technique; Magnetic Resonance Imaging
Department(s): Surgical Oncology
Publisher's Version: https://doi.org/10.1093/bjs/znag053
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2026-05-19 06:10:14

Last Modified: 2026-06-04 04:32:19