Sacrococcygeal teratoma surgery: Difference between revisions
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==Overview== | ==Overview== | ||
Perinatal surgical intervention is used to decrease cardiovascular complications caused by the large 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 complete resection is the mainstay of management of benign tumor. Complete surgical excision in malignant sacrococcygeal teratoma is followed by [[platinum based chemotherapy]].<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> | Perinatal surgical intervention is used to decrease cardiovascular complications caused by the large 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 complete resection is the mainstay of management of benign tumor. Complete surgical excision in malignant sacrococcygeal teratoma is followed by [[platinum based chemotherapy]].<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> | ||
==Management of Fetal Sacrococcygeal Teratoma== | ==Management of Fetal Sacrococcygeal Teratoma== | ||
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===Postnatal Management=== | ===Postnatal Management=== | ||
====Benign Sacrococcygeal Teratoma==== | ====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> | 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 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> | *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> | *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> | ||
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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.[1] Early complete resection is the mainstay of management of benign tumor. Complete surgical excision in malignant sacrococcygeal teratoma is followed by platinum based chemotherapy.[2]
Management of Fetal Sacrococcygeal Teratoma
Perinatal Management
Perinatal intervention is only used to decrease cardiovascular complications caused by the parasitic mass.[1]
Open Fetal Surgery
- 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[3][4]
- Radiofrequency ablation[5][6]
- Bladder drainage for obstructive uropathy[7][8]
- Cyst aspiration[9]
Delivery Option
Fetus with high-risk sacrococcygeal teratoma[1]
- Early delivery by cesarean after 28 weeks of gestation
Fetus with low-risk sacrococcygeal teratoma[1]
- Delivery by cesarean after 36 weeks of gestation
Fetus with small tumor (< 5cm)[10]
- Vaginal delivery
Postnatal Management
Benign Sacrococcygeal Teratoma
Early complete resection is the mainstay of management of benign tumor.[2]
- Complete excision must include removal of coccyx and early ligation of sacral vessels.[11]
- If complete resection can't be achieved with first surgery, a second surgery must be performed.[12]
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
- ↑ 1.0 1.1 1.2 1.3 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.
- ↑ 2.0 2.1 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.
- ↑ 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.
- ↑ 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.