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. This study develops 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: Sixteen colorectal surgeons participated in the study. Ten domains were identified resulting in the development twenty-two 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 specialised centres, and inform future prospective collaborative research.
- 9926863355801891
- Presacral Tumours: an international consensus on diagnosis and management
- William R G PerryKilian G M BrownElaine BurnsQuentin DenostFrank FrizelleThomas E GloverTamara GlynRondell P GrahamAlexander HeriotAmit MercheaAaron QuynPeter SagarMichael J SolomonGregory ThomasJim P TiernanGregory A TurnerSatish WarrierVerity WoodPresacral Tumour Working GroupJohn T JenkinsEric Dozois
- Surgery and Critical Care (UOC)
- British journal of surgery, znag053
- Oxford University Press
- 29/04/2026
- The published version is not available in full-text in OUR Archive. Where available, a link to the published version is provided (check the DOI and/or the Files and links section). The full-text item may be open access on the publisher's website. An earlier version of the work (such as authors' accepted manuscript following peer-review or unreviewed preprint/author's original version) may be available in the Files and links section of this record. Alternatively, readers may have subscription access to the full-text from the publisher.
- English
- Journal article