Objective To investigate the clinical effect of modified surgery via paracral caudal approach in the treatment of benign presacral tumors in adults.Methods The clinical data of 9 adult patients with presacral benign tumors admitted to the third people's Hospital of Yibin City from June 2010 to May 2020 were retrospectively analyzed. All patients were treated with improved surgical methods. The traditional prone folding knife position through the parasacrococcygeal approach was changed to the left lying position and the right lower limb flexion through the parasacrococcygeal approach. The traditional way of sacrococcygeal bone resection to increase exposure was changed to complete sacrococcygeal bone preservation. For some patients with dense adhesion around the tumor, the tumor inner layer epithelial resection was performed in the area of dense adhesion. After tumor resection, the anococcal ligament and pelvic floor muscle were reconstructed in all patients to complete the anatomical reduction of pelvic floor. Results Sacrococcygeal bone was preserved and pelvic floor was reconstructed in all 9 patients. 7 cases were completely resected, 2 cases were subtotal resection and local tumor resection, 8 cases were primary healing, and 1 case was cured by staged operation. All patients were followed up for 1 to 11 years without recurrence.Conclusion The modified operation can significantly reduce the trauma and completely restore the stability of pelvic floor, and reduce the complications of rectum and presacral injury. It is suitable for cystic and solid presacral benign tumors and partial solid benign tumors.