Sacrococcygeal teratoma surgery: Difference between revisions

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*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 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>  
*[[Open fetal surgery]] is the option at some specialized centers.  
*[[Open fetal surgery]] is the option at some specialized centers.  
:*Contraindication to [[open fetal surgery]]:  
*Contraindication to [[open fetal surgery]]:  
::*Type III or IV Altman type tumors
:*Type III or IV Altman type tumors
::*Severe placentomegaly
:*Severe placentomegaly
::*Cervical shortening
:*Cervical shortening
::*Maternal medical issues
:*Maternal medical issues
====Minimally invasive in utero procedures====
====Minimally invasive in utero procedures====
:*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>
*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>
:*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>
*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>
:*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>
*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>
:*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>
*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>
===Delivery Options===
===Delivery Options===
:*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>
*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>
 
:*Early delivery by Cesarean after 28 weeks of gestation
::*Early delivery by Cesarean after 28 weeks of gestation
*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>
:*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>
:*Delivery by Cesarean 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>
::*Delivery by Cesarean after 36 weeks of gestation
:*Vaginal delivery
 
:*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>
 
::*Vaginal delivery


===Postnatal Management===
===Postnatal Management===
Line 41: Line 37:
*Complete surgical excision in malignant sacrococcygeal teratoma is followed by platinum based chemotherapy.  
*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]].
*Most widely used combination of chemotherapy is [[Bleomycin]], [[etoposide]], [[cisplatin]] or [[carboplatin]].
===Relapse===
*


==References==
==References==

Revision as of 05:20, 22 December 2015

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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

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.

Management of fetal SCTs

Perinatal Management

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

Minimally invasive in utero procedures

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

Delivery Options

  • Fetus with high-risk sacrococcygeal teratoma[9]
  • Early delivery by Cesarean after 28 weeks of gestation
  • Fetus with low-risk sacrococcygeal teratoma[10]
  • Delivery by Cesarean after 36 weeks of gestation
  • Fetus with small tumor (<5cm)[11]
  • Vaginal delivery

Postnatal Management

Benign Sacrococcygeal Teratoma

  • Early complete resection is the mainstay of management of benign tumor.[12]
  • Complete excision must include removal of coccyx and early ligation of sacral vessels.[13]
  • If complete resection can't be achieved with first surgery, a second surgery must be performed.[14]

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.

References

  1. ↑ 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. ↑ 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.
  10. ↑ 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.
  11. ↑ 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.
  12. ↑ 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.
  13. ↑ 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.
  14. ↑ 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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