This consensus sets new guidelines for diagnosing and managing presacral tumors, enhancing surgical practices and patient outcomes.

• High-resolution MRI with structured reporting is crucial for risk stratification.
• Image-guided biopsies are necessary for high-risk lesions needing histological confirmation.

Tailor surgical approaches to tumor biology, with complete resection as the goal.

• Non-operative surveillance is advocated for low-risk, asymptomatic cystic lesions.