Long-term functional outcome of sacrococcygeal teratoma after resection in neonates and infants: a single-center experie
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ORIGINAL ARTICLE
Long‑term functional outcome of sacrococcygeal teratoma after resection in neonates and infants: a single‑center experience Kazunori Masahata1,2 · Chihiro Ichikawa3 · Katsutoshi Makino1 · Takatoshi Abe1 · Kiyokazu Kim1 · Taku Yamamichi1 · Ai Tayama1 · Hideki Soh1 · Noriaki Usui1 Accepted: 21 September 2020 / Published online: 29 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose This study aimed to evaluate the incidence and factors associated with long-term functional outcomes of sacrococcygeal teratoma (SCT) after resection in neonates and infants. Methods Twenty-nine patients with a minimum of 3 years of follow-up who underwent resection and were histologically diagnosed with SCTs between 1982 and 2017 at our institution were included. Results The median age at the time of the study was 10.0 years. Functional disorders occurred after surgery in 6 (20.7%) patients. Anorectal dysfunction, urologic dysfunction, and lower-extremity motor disorders occurred in 6 (20.7%), 4 (13.8%), and 3 (10.3%) patients, respectively. One patient with all three types of functional disorders developed intestinal perforation due to ileus and died of sepsis at 13 years of age. The overall mortality rate after tumor resection was 3.4%. The patients who developed functional disorders presented a low 1-min Apgar score, larger tumors requiring abdominosacral resection, surgical injury to the pelvic organs, and immature or malignant histological findings. Conclusion Although the mortality rate was low, the long-term rate of functional disorders after SCT resection was approximately 20%. SCT patients with large tumors, surgical injury to the pelvic organs, and immature or malignant histological findings require thorough follow-up. Keywords Sacrococcygeal teratoma · Functional disorder · Outcome · Complication
Introduction Sacrococcygeal teratoma (SCT) is the most common congenital tumor with a birth prevalence of one of every 35,000–40,000 live births and a female predominance of 4:1 [1–5]. SCT, the most common germ cell tumor in fetuses and neonates, is thought to arise from Hensen’s node, which is located on the coccyx [6]. The majority of such tumors are benign, and basic treatment involves complete tumor resection with coccygectomy. Fetuses with a prenatally diagnosed SCT are at high risk of death due to fetal hydrops, tumor * Kazunori Masahata [email protected]‑u.ac.jp 1
Department of Pediatric Surgery, Osaka Women’s and Children’s Hospital, Izumi, Japan
2
Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan
3
Department of Clinical Pathology, Osaka Women’s and Children’s Hospital, Izumi, Japan
rupture with hemorrhage, umbilical flow obstruction, and high-output cardiac failure due to increased blood flow [7–9]. Despite the rarity of SCT, recent advances in prenatal diagnostic imaging have led to changes in its perinatal management and have improved mortality rates in the neonatal period. However, a reported
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