Sacrococcygeal teratoma surgery: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
No edit summary
Line 17: Line 17:
*Minimally invasive in utero procedures include:
*Minimally invasive in utero procedures include:
::*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>
*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>
::*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>


::*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 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>


::*Vaginal delivery


==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>{{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=}}</re
*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>


===Malignant Sacrococcygeal Teratoma===
===Malignant Sacrococcygeal Teratoma===
 
*Complete surgical excision in malignant sacrococcygeal teratoma is followed by platinum based chemotherapy.  
Management of most fetal SCTs involves [[watch and wait]], also known as [[expectant management]].  An often used [[decision tree]] is as follows:
*Most widely used combination of chemotherapy is [[Bleomycin]], [[etoposide]], [[cisplatin]] or [[carboplatin]].
 
*Perform detailed ultrasound exam including fetal [[echocardiogram]] and [[Doppler]] [[Data-flow analysis|flow analysis]]
**If fetal high output failure, placentomegaly, or [[hydrops]]
***If fetus not mature, perform [[pregnancy termination]] or [[fetal intervention]]
***Else fetus mature, perform emergency [[Cesarean section]]
**Else no emergent problems, perform serial [[non-stress test]]s and ultrasound [[biophysical profile]]s and plan delivery
***If emergent problems develop, return to top of decision tree
***Else if SCT over 5–10cm or [[polyhydramnios]], perform early (37 weeks gestation) [[Caesarean delivery on maternal request|elective Cesarean]] section
***Else SCT small and no complications, permit term [[spontaneous vaginal delivery]]
 
Emergent problems include maternal [[mirror syndrome]], [[polyhydramnios]], and [[preterm labor]].  Poor management decisions, including interventions that are either premature or delayed, can have dire consequences.<ref name="pmid11965727">{{cite journal
| author = Mazneĭkova V, Dimitrova V
| title = [Prenatal ultrasonographic diagnosis of four cases of sacrococcygeal teratoma]
| language = Bulgarian
| journal = Akusherstvo i ginekologii͡a
| volume = 38
| issue = 1
| pages = 64-9
| year = 1999
| pmid = 11965727
| doi =
| issn =
}}</ref><ref name="pmid17525561">{{cite journal
| author = Sheil AT, Collins KA
| title = Fatal birth trauma due to an undiagnosed abdominal teratoma: case report and review of the literature
| journal = The American journal of forensic medicine and pathology : official publication of the National Association of Medical Examiners
| volume = 28
| issue = 2
| pages = 121-7
| year = 2007
| pmid = 17525561
| doi = 10.1097/01.paf.0000257373.91126.0d
| issn =
}}</ref>
 
In many cases, a fetus with a small SCT (under 5 or 10 cm) may be delivered vaginally.<ref name="pmid12475573">{{cite journal
| author = Anteby EY, Yagel S
| title = Route of delivery of fetuses with structural anomalies
| journal = Eur. J. Obstet. Gynecol. Reprod. Biol.
| volume = 106
| issue = 1
| pages = 5-9
| year = 2003
| pmid = 12475573
| doi =
| issn =
}}</ref><ref name="pmid11336088">{{cite journal
| author = Ruangtrakool R, Nitipon A, Laohapensang M, ''et al''
| title = Sacrococcygeal teratoma: 25 year experience
| journal = Journal of the Medical Association of Thailand = Chotmaihet thangphaet
| volume = 84
| issue = 2
| pages = 265-73
| year = 2001
| pmid = 11336088
| doi =
| issn =
}}</ref><ref name="pmid8458172">{{cite journal
| author = McCurdy CM, Seeds JW
| title = Route of delivery of infants with congenital anomalies
| journal = Clinics in perinatology
| volume = 20
| issue = 1
| pages = 81-106
| year = 1993
| pmid = 8458172
| doi =
| issn =
}}</ref><ref name="pmid2205995">{{cite journal
| author = Kainer F, Winter R, Hofmann HM, Karpf EF
| title = [Sacrococcygeal teratoma. Prenatal diagnosis and prognosis]
| language = German
| journal = Zentralblatt für Gynäkologie
| volume = 112
| issue = 10
| pages = 609-16
| year = 1990
| pmid = 2205995
| doi =
| issn =
}}</ref>
==Treatment==
The preferred first treatment for SCT is complete surgical removal (ie, complete resection). The preferred approach to a small SCT is through the [[perineum]]; a large SCT may require an additional approach through the [[abdomen]].  Resection should include the coccyx and may also include portions of the [[sacrum]]. The surgery should include reattachment of the small muscles and ligaments formerly attached to the coccyx, in effect reconstructing the posterior perineum.
 
SCTs are classified morphologically according to how much of them is outside or inside the body:
*Altman Type I — entirely external, sometimes attached to the body only by a narrow '''stalk'''
*Altman Type II
*Altman Type III
*Altman Type IV — entirely internal;  this is a '''presacral teratoma'''
 
The Altman Type has a significant influence on management, surgical approach, and complications of SCT.  Serial ultrasound and MRI monitoring of SCTs in fetuses [[in utero]] has demonstrated that the Altman Type can change over time.
 
Regardless of location in the body, [[teratoma]]s are classified according to a [[cancer staging]] system.  This indicates whether [[chemotherapy]] or [[radiation therapy]] may be needed.


==References==
==References==
Line 139: Line 52:
[[Category:Pediatric cancers]]
[[Category:Pediatric cancers]]
[[Category:Mature chapter]]
[[Category:Mature chapter]]
[[de:Steißbeinteratom]]
[[es:Teratoma sacrococcígeo]]
[[es:Teratoma sacrococcígeo]]
[[fr:Tératome sacro-coccygien]]
[[fr:Tératome sacro-coccygien]]
[[it:Teratoma sacro-coccigeo]]
{{WikiDoc Help Menu}}
{{WikiDoc Help Menu}}
{{WikiDoc Sources}}
{{WikiDoc Sources}}

Revision as of 20:16, 15 December 2015

Sacrococcygeal teratoma Microchapters

Home

Patient Information

Overview

Historical perspective

Classification

Pathophysiology

Causes

Differentiating Sacrococcygeal teratoma from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural history, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History & Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Sacrococcygeal teratoma surgery On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Sacrococcygeal teratoma surgery

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Sacrococcygeal teratoma surgery

CDC on Sacrococcygeal teratoma surgery

Sacrococcygeal teratoma surgery in the news

Blogs on Sacrococcygeal teratoma surgery

Directions to Hospitals Treating Sacrococcygeal teratoma

Risk calculators and risk factors for Sacrococcygeal teratoma surgery

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:
  • Type III or IV Altman type tumors
  • Severe placentomegaly
  • Cervical shortening
  • Maternal medical issues
  • Minimally invasive in utero procedures include:
  • 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.

Template:WikiDoc Sources

Retrieved from "https://www.wikidoc.org/index.php?title=Sacrococcygeal_teratoma_surgery&oldid=1194987"