Sacrococcygeal teratoma surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Mirdula Sharma, MBBS [2]

Overview[edit | edit source]

Perinatal surgical intervention is used to decrease cardiovascular complications caused by the large sacrococcygeal teratoma. Early complete resection is the mainstay of management of benign tumor. Complete surgical excision in malignant sacrococcygeal teratoma is followed by platinum based chemotherapy.

Surgery[edit | edit source]

Perinatal Management[edit | edit source]

Perinatal intervention is only used to decrease cardiovascular complications caused by the parasitic mass.^[1]

Open Fetal Surgery[edit | edit source]

Open fetal surgery is the option at some specialized centers.
Contraindication to open fetal surgery:

Type III or IV Altman type tumors
Severe placentomegaly
Cervical shortening
Maternal medical conditions

Minimally Invasive in Utero Procedures[edit | edit source]

Laser ablation^[2]^[3]
Radiofrequency ablation^[4]^[5]
Bladder drainage for obstructive uropathy^[6]^[7]
Cyst aspiration^[8]

Delivery Option[edit | edit source]

Fetus with High-risk Sacrococcygeal Teratoma^[1]

Early delivery by cesarean section after 28 weeks of gestation

Fetus with Low-risk Sacrococcygeal Teratoma^[1]

Delivery by cesarean section after 36 weeks of gestation

Fetus with Small Tumor (< 5cm)^[9]

Vaginal delivery

Postnatal Management[edit | edit source]

Benign Sacrococcygeal Teratoma[edit | edit source]

Early complete resection is the mainstay of management of benign tumor.^[10]

Complete excision must include removal of coccyx and early ligation of sacral blood vessels.^[11]
If complete resection can not be achieved with first surgery, a second surgery must be performed.^[12]

Malignant Sacrococcygeal Teratoma[edit | edit source]

Complete surgical excision in malignant sacrococcygeal teratoma is followed by platinum based chemotherapy.
Most widely used combination of chemotherapy is Bleomycin, etoposide, cisplatin or carboplatin.

References[edit | edit source]

↑ ^1.0 ^1.1 ^1.2 Roybal JL, Moldenhauer JS, Khalek N, Bebbington MW, Johnson MP, Hedrick HL, Adzick NS, Flake AW (2011). "Early delivery as an alternative management strategy for selected high-risk fetal sacrococcygeal teratomas". J. Pediatr. Surg. 46 (7): 1325–32. doi:10.1016/j.jpedsurg.2010.10.020. PMID 21763829.
↑ Makin EC, Hyett J, Ade-Ajayi N, Patel S, Nicolaides K, Davenport M (2006). "Outcome of antenatally diagnosed sacrococcygeal teratomas: single-center experience (1993-2004)". J. Pediatr. Surg. 41 (2): 388–93. doi:10.1016/j.jpedsurg.2005.11.017. PMID 16481257.
↑ Hecher K, Hackelöer BJ (1996). "Intrauterine endoscopic laser surgery for fetal sacrococcygeal teratoma". Lancet. 347 (8999): 470. PMID 8618503.
↑ Lam YH, Tang MH, Shek TW (2002). "Thermocoagulation of fetal sacrococcygeal teratoma". Prenat. Diagn. 22 (2): 99–101. PMID 11857611.
↑ Paek BW, Jennings RW, Harrison MR, Filly RA, Tacy TA, Farmer DL, Albanese CT (2001). "Radiofrequency ablation of human fetal sacrococcygeal teratoma". Am. J. Obstet. Gynecol. 184 (3): 503–7. doi:10.1067/mob.2001.110446. PMID 11228510.
↑ Wilson RD, Hedrick H, Flake AW, Johnson MP, Bebbington MW, Mann S, Rychik J, Liechty K, Adzick NS (2009). "Sacrococcygeal teratomas: prenatal surveillance, growth and pregnancy outcome". Fetal. Diagn. Ther. 25 (1): 15–20. doi:10.1159/000188056. PMID 19122459.
↑ Scrimgeour EM, Brown P (1991). "BSE and potential risks to slaughtermen". Vet. Rec. 129 (17): 390–1. PMID 1746122.
↑ Lee MY, Won HS, Hyun MK, Lee HY, Shim JY, Lee PR, Kim A (2011). "Perinatal outcome of sacrococcygeal teratoma". Prenat. Diagn. 31 (13): 1217–21. doi:10.1002/pd.2865. PMID 22024911.
↑ Okada T, Sasaki F, Cho K, Honda S, Naito S, Hirokata G, Todo S (2008). "Management and outcome in prenatally diagnosed sacrococcygeal teratomas". Pediatr Int. 50 (4): 576–80. doi:10.1111/j.1442-200X.2008.02703.x. PMID 18937757.
↑ Marina NM, Cushing B, Giller R, Cohen L, Lauer SJ, Ablin A, Weetman R, Cullen J, Rogers P, Vinocur C, Stolar C, Rescorla F, Hawkins E, Heifetz S, Rao PV, Krailo M, Castleberry RP (1999). "Complete surgical excision is effective treatment for children with immature teratomas with or without malignant elements: A Pediatric Oncology Group/Children's Cancer Group Intergroup Study". J. Clin. Oncol. 17 (7): 2137–43. PMID 10561269.
↑ Ein SH, Mancer K, Adeyemi SD (1985). "Malignant sacrococcygeal teratoma--endodermal sinus, yolk sac tumor--in infants and children: a 32-year review". J. Pediatr. Surg. 20 (5): 473–7. PMID 3903096.
↑ Calaminus G, Schneider DT, Bökkerink JP, Gadner H, Harms D, Willers R, Göbel U (2003). "Prognostic value of tumor size, metastases, extension into bone, and increased tumor marker in children with malignant sacrococcygeal germ cell tumors: a prospective evaluation of 71 patients treated in the German cooperative protocols Maligne Keimzelltumoren (MAKEI) 83/86 and MAKEI 89". J. Clin. Oncol. 21 (5): 781–6. PMID 12610174.

Template:WikiDoc Sources

[tt-1] 1.0 ^1.1 ^1.2 Roybal JL, Moldenhauer JS, Khalek N, Bebbington MW, Johnson MP, Hedrick HL, Adzick NS, Flake AW (2011). "Early delivery as an alternative management strategy for selected high-risk fetal sacrococcygeal teratomas". J. Pediatr. Surg. 46 (7): 1325–32. doi:10.1016/j.jpedsurg.2010.10.020. PMID 21763829.

[2] Makin EC, Hyett J, Ade-Ajayi N, Patel S, Nicolaides K, Davenport M (2006). "Outcome of antenatally diagnosed sacrococcygeal teratomas: single-center experience (1993-2004)". J. Pediatr. Surg. 41 (2): 388–93. doi:10.1016/j.jpedsurg.2005.11.017. PMID 16481257.

[3] Hecher K, Hackelöer BJ (1996). "Intrauterine endoscopic laser surgery for fetal sacrococcygeal teratoma". Lancet. 347 (8999): 470. PMID 8618503.

[4] Lam YH, Tang MH, Shek TW (2002). "Thermocoagulation of fetal sacrococcygeal teratoma". Prenat. Diagn. 22 (2): 99–101. PMID 11857611.

[5] Paek BW, Jennings RW, Harrison MR, Filly RA, Tacy TA, Farmer DL, Albanese CT (2001). "Radiofrequency ablation of human fetal sacrococcygeal teratoma". Am. J. Obstet. Gynecol. 184 (3): 503–7. doi:10.1067/mob.2001.110446. PMID 11228510.

[6] Wilson RD, Hedrick H, Flake AW, Johnson MP, Bebbington MW, Mann S, Rychik J, Liechty K, Adzick NS (2009). "Sacrococcygeal teratomas: prenatal surveillance, growth and pregnancy outcome". Fetal. Diagn. Ther. 25 (1): 15–20. doi:10.1159/000188056. PMID 19122459.

[7] Scrimgeour EM, Brown P (1991). "BSE and potential risks to slaughtermen". Vet. Rec. 129 (17): 390–1. PMID 1746122.

[8] Lee MY, Won HS, Hyun MK, Lee HY, Shim JY, Lee PR, Kim A (2011). "Perinatal outcome of sacrococcygeal teratoma". Prenat. Diagn. 31 (13): 1217–21. doi:10.1002/pd.2865. PMID 22024911.

[9] Okada T, Sasaki F, Cho K, Honda S, Naito S, Hirokata G, Todo S (2008). "Management and outcome in prenatally diagnosed sacrococcygeal teratomas". Pediatr Int. 50 (4): 576–80. doi:10.1111/j.1442-200X.2008.02703.x. PMID 18937757.

[txchemo-10] Marina NM, Cushing B, Giller R, Cohen L, Lauer SJ, Ablin A, Weetman R, Cullen J, Rogers P, Vinocur C, Stolar C, Rescorla F, Hawkins E, Heifetz S, Rao PV, Krailo M, Castleberry RP (1999). "Complete surgical excision is effective treatment for children with immature teratomas with or without malignant elements: A Pediatric Oncology Group/Children's Cancer Group Intergroup Study". J. Clin. Oncol. 17 (7): 2137–43. PMID 10561269.

[11] Ein SH, Mancer K, Adeyemi SD (1985). "Malignant sacrococcygeal teratoma--endodermal sinus, yolk sac tumor--in infants and children: a 32-year review". J. Pediatr. Surg. 20 (5): 473–7. PMID 3903096.

[12] Calaminus G, Schneider DT, Bökkerink JP, Gadner H, Harms D, Willers R, Göbel U (2003). "Prognostic value of tumor size, metastases, extension into bone, and increased tumor marker in children with malignant sacrococcygeal germ cell tumors: a prospective evaluation of 71 patients treated in the German cooperative protocols Maligne Keimzelltumoren (MAKEI) 83/86 and MAKEI 89". J. Clin. Oncol. 21 (5): 781–6. PMID 12610174.

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