Elsevier

Journal of Pediatric Surgery

Volume 41, Issue 9, September 2006, Pages 1513-1516
Journal of Pediatric Surgery

Original article
Sacrococcygeal teratoma—a 25-year experience in a UK regional center

https://doi.org/10.1016/j.jpedsurg.2006.05.019Get rights and content

Abstract

Background

Sacrococcygeal teratoma (SCT) is uncommon (1:35,000-1:40,000 newborns). We report a 25-year single-center experience with a focus on late effects.

Methods

Surgical and tumor registries identified patients with SCT between 1977 and 2001. Perinatal data, associated anomalies, operative findings, histology, and survival were recorded. Continence was assessed clinically. Urodynamics and anorectal manometry were performed as indicated.

Results

Thirty-three patients (28 females) were treated for SCT. Before 1988, 2 of 18 were diagnosed antenatally compared with 8 of 15 between 1988 and 2001. Ten babies were delivered by cesarean birth. Seven children presented after the neonatal period. Surgery comprised tumor excision with coccygectomy. Histology was benign in 26 (79%), malignant in 6 (18%), and immature in a single patient. Presentation beyond the newborn period was associated with malignant disease and poorer outcome. Overall survival was 94%. Neuropathic bladder or bowel disturbance was identified in 7 of 20 patients on long-term follow-up.

Conclusions

Antenatal diagnosis of SCT appears to be increasing. Parental counseling should include the continence problems that may follow removal of even benign tumors. Resection by surgical oncologists and reconstruction by colorectal specialists may improve function. Follow-up by oncologists, surgeons, and urologists remains an important part of SCT management.

Section snippets

Patients and methods

The neonatal surgery database and regional tumor registry were accessed to identify all patients with SCT treated at the Royal Liverpool Children's Hospital (Alder Hey) between 1977 and 2001 inclusive. Patient demographics including antenatal details, mode of delivery, age at presentation, sex, associated anomalies, and tumor histology were recorded. Surgical management with respect to resection of the primary tumor, and early and late postoperative complications were noted. Outcomes relating

Results

Thirty-three patients with a diagnosis of SCT were treated during the study period. There were 28 females and 5 males. Before 1988, only 2 (11%) of 18 patients had tumors diagnosed by antenatal ultrasonography compared with 8 of 15 (53%) in the years 1988 to 2001. Average birth weight was 3.3 kg (range, 1.5-4.9 kg) and mean age at delivery was 37 weeks (range, 30-41 weeks). Ten babies were delivered by cesarean birth for obstetric and/or fetal indications. Seven (21%) patients presented after

Discussion

We report one of the largest SCT series from a single European center. Data from this 25-year study confirm a female predominance, incidence of associated anomalies, and typical presentation of “monstrous” neonatal lesions [1], [4], [9]. Before the late 1980s, while detection of fetal SCT was low (11%), it is of interest that neonatal morbidity was not encountered from unplanned vaginal delivery. Antenatal diagnosis was achieved in more than 50% of the patient population from 1988 to 2001 [2],

Acknowledgments

The authors thank past and present colleagues in medical oncology, radiology, pediatric surgery, and urology for their skill, support, and contribution to patient care. We also acknowledge the professional cooperation of Mr Steve Walkinshaw and Professor Zarco Alfiveric at the Fetal Treatment Centre, Liverpool Women's Hospital.

References (17)

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Cited by (87)

  • Long-Term Outcome of Sacrococcygeal Teratoma: A Controlled Cohort Study of Urinary Tract and Bowel Dysfunction and Predictors of Poor Outcome

    2018, Journal of Pediatrics
    Citation Excerpt :

    Previous studies have shown a substantial heterogeneity in the frequency of urinary tract and bowel dysfunction following surgical excision of sacrococcygeal teratoma.9-19 Problems with respect to bladder voiding dysfunction, straining, incontinence, enuresis, and neurogenic bladder have been reported in 7%-55%.9-19 Our study showed urinary tract dysfunction in 29% of the children with sacrococcygeal teratoma, which is comparable with the observations in 1 of the largest studies, of 79 children with sacrococcygeal teratoma, which reported 31% with urinary incontinence.10

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This work was presented at the Joint Meeting of The International Society of Paediatric Oncology (SIOP XXXV) and the International Society of Pediatric Surgical Oncology (IPSO XXXV), Cairo, Egypt, October 8 to 11, 2003, and published as abstract O026 in the conference proceedings [Med Pediatr Oncol 2003;41(4): 263-4].

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