Background: Low-sited presacral intrapelvic malignant tumors represent one of the challenging situations for surgeons. 
Laparotomy alone often does not provide adequate exposure for complete excision of a midline intrapelvic tumor. 
Objective: To evaluate, describe and discuss the use of PMA in the treatment of intrapelvic malignant tumors which are too high to be approached through the perineum and too low to be excised by laparotomy alone. 
Patients: A prospective study of eighteen patients suffering from documented malignant low-sited intrapelvic tumors. 
Methods: All patients were subjected to tumor excision through the posterior midsagittal approach. After excision, the 
rectum was placed in the normal position. The pelvic floor muscles were reconstructed in the midline. 
Results: The size of the completely resected tumors ranged from 2.5 x 4 cm to 7 x 11.5 cm. Complete excision was amenable in 15 patients (83.33%), while in three patients only partial tumor excision could be done. Histopathological results of resected tumors showed the predominance of prostatic rhabdomyosarcoma in male patients and mature teratoma in female patients. 
Postoperatively, no complications were recorded. In all the nine patients above 4 years-old, fecal continence was not affected.
The function of the bladder remained undisturbed in all patients. Postoperative follow up of patients revealed that patients with complete tumor excision (83.33%) were disease-free during the whole follow-up period, (mean of 24.5 ± 5.33 months). 
Conclusion: Based on the results of this study, it can be concluded that PMA is a safe effective procedure for the radical 
excision of Intrapelvic malignant tumors which are too low to be approached through the perineum and too high to be 
reached by laparotomy alone.