Sacrococcygeal teratoma surgery: Difference between revisions

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==Overview==
==Overview==
'''Sacrococcygeal teratoma''' (SCT) is a [[teratoma]] (a kind of tumor) located at the base of the [[coccyx]] (tailbone). It is thought to be a derivative of the [[primitive streak]].
[[Perinatal period|Perinatal]] [[Surgery|surgical]] intervention is used to decrease [[cardiovascular]] [[Complication (medicine)|complications]] caused by the large sacrococcygeal teratoma. Early complete [[resection]] is the mainstay of management of [[benign tumor]]. Complete [[Surgery|surgical]] [[excision]] in [[malignant]] sacrococcygeal teratoma is followed by [[Chemotherapy|platinum based chemotherapy]].


==Management of fetal SCTs==
==Surgery==
===Perinatal Management===
===Perinatal Management===
*Perinatal intervention is only used to decrease cardiovascular complications caused by parasitic mass.<ref>{{cite journal |vauthors=Roybal JL, Moldenhauer JS, Khalek N, Bebbington MW, Johnson MP, Hedrick HL, Adzick NS, Flake AW |title=Early delivery as an alternative management strategy for selected high-risk fetal sacrococcygeal teratomas |journal=J. Pediatr. Surg. |volume=46 |issue=7 |pages=1325–32 |year=2011 |pmid=21763829 |doi=10.1016/j.jpedsurg.2010.10.020 |url=}}</ref>  
[[Perinatal period|Perinatal]] intervention is only used to decrease [[cardiovascular]] [[Complication (medicine)|complications]] caused by the parasitic mass.<ref name="tt">{{cite journal |vauthors=Roybal JL, Moldenhauer JS, Khalek N, Bebbington MW, Johnson MP, Hedrick HL, Adzick NS, Flake AW |title=Early delivery as an alternative management strategy for selected high-risk fetal sacrococcygeal teratomas |journal=J. Pediatr. Surg. |volume=46 |issue=7 |pages=1325–32 |year=2011 |pmid=21763829 |doi=10.1016/j.jpedsurg.2010.10.020 |url=}}</ref>
*Open fetal surgery is the option at some specialized centers.  
====Open Fetal Surgery====
:*Contraindication:  
*Open [[Fetus|fetal]] [[surgery]] is the option at some specialized centers.  
::*Type III or IV Altman type tumors
*[[Contraindication]] to open [[Fetus|fetal]] [[surgery]]:  
::*Severe placentomegaly
:*Type III or IV Altman type [[Tumor|tumors]]
::*Cervical shortening
:*Severe [[placentomegaly]]
::*Maternal medical issues
:*[[Cervix|Cervical]] shortening
*Minimally invasive in utero procedures include:
:*Maternal [[medical conditions]]
::*Laser ablation<ref>{{cite journal |vauthors=Makin EC, Hyett J, Ade-Ajayi N, Patel S, Nicolaides K, Davenport M |title=Outcome of antenatally diagnosed sacrococcygeal teratomas: single-center experience (1993-2004) |journal=J. Pediatr. Surg. |volume=41 |issue=2 |pages=388–93 |year=2006 |pmid=16481257 |doi=10.1016/j.jpedsurg.2005.11.017 |url=}}</ref><ref>{{cite journal |vauthors=Hecher K, Hackelöer BJ |title=Intrauterine endoscopic laser surgery for fetal sacrococcygeal teratoma |journal=Lancet |volume=347 |issue=8999 |pages=470 |year=1996 |pmid=8618503 |doi= |url=}}</ref>
====Minimally Invasive in Utero Procedures====
::*Radiofrequency ablation<ref>{{cite journal |vauthors=Lam YH, Tang MH, Shek TW |title=Thermocoagulation of fetal sacrococcygeal teratoma |journal=Prenat. Diagn. |volume=22 |issue=2 |pages=99–101 |year=2002 |pmid=11857611 |doi= |url=}}</ref><ref>{{cite journal |vauthors=Paek BW, Jennings RW, Harrison MR, Filly RA, Tacy TA, Farmer DL, Albanese CT |title=Radiofrequency ablation of human fetal sacrococcygeal teratoma |journal=Am. J. Obstet. Gynecol. |volume=184 |issue=3 |pages=503–7 |year=2001 |pmid=11228510 |doi=10.1067/mob.2001.110446 |url=}}</ref>
*[[Laser ablation]]<ref>{{cite journal |vauthors=Makin EC, Hyett J, Ade-Ajayi N, Patel S, Nicolaides K, Davenport M |title=Outcome of antenatally diagnosed sacrococcygeal teratomas: single-center experience (1993-2004) |journal=J. Pediatr. Surg. |volume=41 |issue=2 |pages=388–93 |year=2006 |pmid=16481257 |doi=10.1016/j.jpedsurg.2005.11.017 |url=}}</ref><ref>{{cite journal |vauthors=Hecher K, Hackelöer BJ |title=Intrauterine endoscopic laser surgery for fetal sacrococcygeal teratoma |journal=Lancet |volume=347 |issue=8999 |pages=470 |year=1996 |pmid=8618503 |doi= |url=}}</ref>
::*Bladder drainage for obstructive uropathy<ref>{{cite journal |vauthors=Wilson RD, Hedrick H, Flake AW, Johnson MP, Bebbington MW, Mann S, Rychik J, Liechty K, Adzick NS |title=Sacrococcygeal teratomas: prenatal surveillance, growth and pregnancy outcome |journal=Fetal. Diagn. Ther. |volume=25 |issue=1 |pages=15–20 |year=2009 |pmid=19122459 |doi=10.1159/000188056 |url=}}</ref><ref>{{cite journal |vauthors=Scrimgeour EM, Brown P |title=BSE and potential risks to slaughtermen |journal=Vet. Rec. |volume=129 |issue=17 |pages=390–1 |year=1991 |pmid=1746122 |doi= |url=}}</ref>
*[[Radiofrequency ablation]]<ref>{{cite journal |vauthors=Lam YH, Tang MH, Shek TW |title=Thermocoagulation of fetal sacrococcygeal teratoma |journal=Prenat. Diagn. |volume=22 |issue=2 |pages=99–101 |year=2002 |pmid=11857611 |doi= |url=}}</ref><ref>{{cite journal |vauthors=Paek BW, Jennings RW, Harrison MR, Filly RA, Tacy TA, Farmer DL, Albanese CT |title=Radiofrequency ablation of human fetal sacrococcygeal teratoma |journal=Am. J. Obstet. Gynecol. |volume=184 |issue=3 |pages=503–7 |year=2001 |pmid=11228510 |doi=10.1067/mob.2001.110446 |url=}}</ref>
::*Cyst aspiration<ref>{{cite journal |vauthors=Lee MY, Won HS, Hyun MK, Lee HY, Shim JY, Lee PR, Kim A |title=Perinatal outcome of sacrococcygeal teratoma |journal=Prenat. Diagn. |volume=31 |issue=13 |pages=1217–21 |year=2011 |pmid=22024911 |doi=10.1002/pd.2865 |url=}}</ref>
*[[Urinary bladder|Bladder]] drainage for [[obstructive uropathy]]<ref>{{cite journal |vauthors=Wilson RD, Hedrick H, Flake AW, Johnson MP, Bebbington MW, Mann S, Rychik J, Liechty K, Adzick NS |title=Sacrococcygeal teratomas: prenatal surveillance, growth and pregnancy outcome |journal=Fetal. Diagn. Ther. |volume=25 |issue=1 |pages=15–20 |year=2009 |pmid=19122459 |doi=10.1159/000188056 |url=}}</ref><ref>{{cite journal |vauthors=Scrimgeour EM, Brown P |title=BSE and potential risks to slaughtermen |journal=Vet. Rec. |volume=129 |issue=17 |pages=390–1 |year=1991 |pmid=1746122 |doi= |url=}}</ref>
*Delivery options:
*[[Cyst]] [[aspiration]]<ref>{{cite journal |vauthors=Lee MY, Won HS, Hyun MK, Lee HY, Shim JY, Lee PR, Kim A |title=Perinatal outcome of sacrococcygeal teratoma |journal=Prenat. Diagn. |volume=31 |issue=13 |pages=1217–21 |year=2011 |pmid=22024911 |doi=10.1002/pd.2865 |url=}}</ref>
:*Fetus with high-risk sacrococcygeal teratoma<ref>{{cite journal |vauthors=Roybal JL, Moldenhauer JS, Khalek N, Bebbington MW, Johnson MP, Hedrick HL, Adzick NS, Flake AW |title=Early delivery as an alternative management strategy for selected high-risk fetal sacrococcygeal teratomas |journal=J. Pediatr. Surg. |volume=46 |issue=7 |pages=1325–32 |year=2011 |pmid=21763829 |doi=10.1016/j.jpedsurg.2010.10.020 |url=}}</ref>
===Delivery Option===
'''Fetus with High-risk Sacrococcygeal Teratoma'''<ref name="tt">{{cite journal |vauthors=Roybal JL, Moldenhauer JS, Khalek N, Bebbington MW, Johnson MP, Hedrick HL, Adzick NS, Flake AW |title=Early delivery as an alternative management strategy for selected high-risk fetal sacrococcygeal teratomas |journal=J. Pediatr. Surg. |volume=46 |issue=7 |pages=1325–32 |year=2011 |pmid=21763829 |doi=10.1016/j.jpedsurg.2010.10.020 |url=}}</ref>
*Early [[Childbirth|delivery]] by [[Caesarean section|cesarean section]] after 28 weeks of [[gestation]]
'''Fetus with Low-risk Sacrococcygeal Teratoma'''<ref name="tt">{{cite journal |vauthors=Roybal JL, Moldenhauer JS, Khalek N, Bebbington MW, Johnson MP, Hedrick HL, Adzick NS, Flake AW |title=Early delivery as an alternative management strategy for selected high-risk fetal sacrococcygeal teratomas |journal=J. Pediatr. Surg. |volume=46 |issue=7 |pages=1325–32 |year=2011 |pmid=21763829 |doi=10.1016/j.jpedsurg.2010.10.020 |url=}}</ref>
*[[Childbirth|Delivery]] by [[Caesarean section|cesarean section]] after 36 weeks of [[gestation]]
'''Fetus with Small Tumor''' '''(< 5cm)'''<ref>{{cite journal |vauthors=Okada T, Sasaki F, Cho K, Honda S, Naito S, Hirokata G, Todo S |title=Management and outcome in prenatally diagnosed sacrococcygeal teratomas |journal=Pediatr Int |volume=50 |issue=4 |pages=576–80 |year=2008 |pmid=18937757 |doi=10.1111/j.1442-200X.2008.02703.x |url=}}</ref>
*[[Vagina|Vaginal]] [[Childbirth|delivery]]


::*Early delivery by Cesarean after 28 weeks of gestation
===Postnatal Management===
:*Fetus with low-risk sacrococcygeal teratoma<ref>{{cite journal |vauthors=Roybal JL, Moldenhauer JS, Khalek N, Bebbington MW, Johnson MP, Hedrick HL, Adzick NS, Flake AW |title=Early delivery as an alternative management strategy for selected high-risk fetal sacrococcygeal teratomas |journal=J. Pediatr. Surg. |volume=46 |issue=7 |pages=1325–32 |year=2011 |pmid=21763829 |doi=10.1016/j.jpedsurg.2010.10.020 |url=}}</ref>
====Benign Sacrococcygeal Teratoma====
Early complete [[resection]] is the mainstay of management of [[benign tumor]].<ref name="txchemo">{{cite journal |vauthors=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 |title=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 |journal=J. Clin. Oncol. |volume=17 |issue=7 |pages=2137–43 |year=1999 |pmid=10561269 |doi= |url=}}</ref>
*Complete [[excision]] must include removal of [[coccyx]] and early ligation of [[Sacrum|sacral]] [[Blood vessel|blood vessels]].<ref>{{cite journal |vauthors=Ein SH, Mancer K, Adeyemi SD |title=Malignant sacrococcygeal teratoma--endodermal sinus, yolk sac tumor--in infants and children: a 32-year review |journal=J. Pediatr. Surg. |volume=20 |issue=5 |pages=473–7 |year=1985 |pmid=3903096 |doi= |url=}}</ref>
*If complete [[resection]] can not be achieved with first [[surgery]], a second [[surgery]] must be performed.<ref>{{cite journal |vauthors=Calaminus G, Schneider DT, Bökkerink JP, Gadner H, Harms D, Willers R, Göbel U |title=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 |journal=J. Clin. Oncol. |volume=21 |issue=5 |pages=781–6 |year=2003 |pmid=12610174 |doi= |url=}}</ref>


::*Delivery by Cesarean after 36 weeks of gestation
====Malignant Sacrococcygeal Teratoma====
 
*Complete [[Surgery|surgical]] [[excision]] in [[malignant]] sacrococcygeal teratoma is followed by [[Chemotherapy|platinum based chemotherapy]].  
:*Fetus with small tumor (<5cm)<ref>{{cite journal |vauthors=Okada T, Sasaki F, Cho K, Honda S, Naito S, Hirokata G, Todo S |title=Management and outcome in prenatally diagnosed sacrococcygeal teratomas |journal=Pediatr Int |volume=50 |issue=4 |pages=576–80 |year=2008 |pmid=18937757 |doi=10.1111/j.1442-200X.2008.02703.x |url=}}</ref>
*Most widely used combination of [[chemotherapy]] is [[Bleomycin]], [[etoposide]], [[cisplatin]] or [[carboplatin]].
 
::*Vaginal delivery
 
==Postnatal Management==
===Benign Sacrococcygeal Teratoma===
*Early complete resection is the mainstay of management of benign tumor.<ref>{{cite journal |vauthors=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 |title=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 |journal=J. Clin. Oncol. |volume=17 |issue=7 |pages=2137–43 |year=1999 |pmid=10561269 |doi= |url=}}</ref>
:*Complete excision must include removal of coccyx and early ligation of sacral vessels.<ref>{{cite journal |vauthors=Ein SH, Mancer K, Adeyemi SD |title=Malignant sacrococcygeal teratoma--endodermal sinus, yolk sac tumor--in infants and children: a 32-year review |journal=J. Pediatr. Surg. |volume=20 |issue=5 |pages=473–7 |year=1985 |pmid=3903096 |doi= |url=}}</ref>
:*If complete resection can't be achieved with first surgery, a second surgery must be performed.<ref>{{cite journal |vauthors=Calaminus G, Schneider DT, Bökkerink JP, Gadner H, Harms D, Willers R, Göbel U |title=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 |journal=J. Clin. Oncol. |volume=21 |issue=5 |pages=781–6 |year=2003 |pmid=12610174 |doi= |url=}}</ref>
 
===Malignant Sacrococcygeal Teratoma===
*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]].
 
===Relapse===
*


==References==
==References==
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Latest revision as of 21:16, 7 May 2019

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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

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

Perinatal Management

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

Open Fetal Surgery

Minimally Invasive in Utero Procedures

Delivery Option

Fetus with High-risk Sacrococcygeal Teratoma[1]

Fetus with Low-risk Sacrococcygeal Teratoma[1]

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

Postnatal Management

Benign Sacrococcygeal Teratoma

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

Malignant Sacrococcygeal Teratoma

References

  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.
  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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