Epidemiology, diagnostic approach and therapeutic management of tailgut
cysts: A systematic review
Mastoraki, Aikaterini
Giannakodimos, Ilias
Panagiotou, Karmia
and Frountzas, Maximos
Chrysikos, Dimosthenis
Kykalos, Stylianos
and Theodoropoulos, Georgios E.
Schizas, Dimitrios
Background Tailgut cysts (TGCs) are benign congenital abnormalities that
usually present with non-specific symptoms, constituting a diagnostic
dilemma for physicians. The aim of this study was to systematically
review the literature concerning clinical manifestations, diagnostic
modalities and histologic findings of TGCs and highlight current
knowledge on therapeutic management of this rare entity. Methods PubMed
and Embase databases were systematically searched by two independent
investigators (last search 18 February 2021) for studies concerning TGCs
published in the past two decades. Results Totally, 144 articles,
including 135 case reports and 9 case series, met our inclusion
criteria. One hundred eighty-four patients were included
(3:1/female:male) with an age of 42.3 +/- 18.7 years (mean, SD), while 5
cases concerned new-born infants. Pain was the prevailing clinical
manifestation (41.8%), whereas 16.8% were asymptomatic. MRI and CT
were utilized for diagnosis in 58.7% and 54.7% of cases, respectively.
The majority of cysts were multilocular, while ciliated columnar
epithelium and smooth muscles of the cyst wall were the prevailed
histological findings. Malignant degeneration of TGCs was reported in
32.1% of cases, while carcinoid tumours were the most frequent
malignancies. Surgical resection was performed in 155 cases, while
laparoscopic and robotic approach was preferred in 18 and 2 cases,
respectively. A posterior approach was implemented in 80.9%, anterior
technique in 9% and combined technique in 6.7% of cases. Postoperative
complications and recurrence of the cystic lesion were reported in
17.4% and 7.6% of cases, respectively. Conclusions TGCs constitute a
dilemma for the physicians. Surgical resection comprises the ultimate
treatment to avoid complications or malignant transformation of the
cyst. Concrete follow-up strategies and optimal therapeutic options
should be outlined through consensus guidelines and at the time being,
such decisions can be made only on the basis of extrapolation and on a
case-by-case approach.
(EN)
