How are sacrococcygeal teratomas treated?

Updated: Nov 22, 2019
  • Author: Chad A Hamilton, MD; Chief Editor: Yukio Sonoda, MD  more...
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Answer

Sacrococcygeal teratomas diagnosed prenatally should be monitored closely. In high-risk (large, solid, vascular) sacrococcygeal teratoma, in utero surgery may be an option in carefully selected cases. In the presence of developing hydrops, other minimally invasive antenatal procedures such as fetoscopic laser ablation, radiofrequency ablation, interstitial laser ablation, or vascular coiling may be options to interrupt the vascular flow to the tumor. In selected high-risk fetuses, early delivery and ex utero surgery may be an option. [52, 53]

In fetuses with larger tumors, cesarean delivery should be considered to prevent dystocia or tumor rupture. Because of the poor prognosis associated with development of hydrops prior to 30 weeks' gestation, these fetuses may benefit from in utero surgery. In most cases, sacrococcygeal teratomas should be resected electively in the first week of life, since long delays may be associated with a higher rate of malignancy. [54]

Complete excision should be done through a chevron-shaped buttock incision, with careful attention to the preservation of the muscles of the rectal sphincter. The coccyx always should be resected with the tumor, as failure to do so results in a 35-40% recurrence rate. Hemorrhage from the middle sacral vessels and hypogastric arteries is the most common complication. [6]


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