Table 1 Advantages and disadvantages of each approach for presacral tumor resection
| Â | Posterior approach | Transabdominal approach |
|---|---|---|
Advantages | - Short distance to the tumor. - Direct dissection around the coccyx or levator ani muscle. - Coccygectomy can be added. | - Cranial side of large tumors (> 10 cm) can be exposed easily. |
Disadvantages | - Risk of injury to hypogastric nerves and median sacral vessels. - Exposure of the cranial side of the tumor is difficult. | - Dissection around the lower rectum is difficult. - Risk of injury to proximal part of the mesentery (which may require resection of the rectum and/or stoma creation). - Risk of peritoneal dissemination. - Risk of adhesive intestinal obstruction. |