Sacrococcygeal teratoma: evaluation of its approach, treatment and follow-up in two reference children cancer centers in Brazil / Rio de Janeiro

Abstract

Introduction: sacrococcygeal teratoma (TSC) is the most common tumor of the neonatal period. Alphafetoprotein is an important tumor marker and is used in the follow-up period as a marker of malignancy. The complete surgical resection of the tumor associated with coccygectomy is the standard treatment and chemotherapy in different stages are necessary. Follow-up consists of serial exam: tumor markers, imaging searching to possible metastasis sites, in addition to a complete physical examination. Methodology: a descriptive, retrospective, study was carried out by analyzing a chart of 25 patients of two different reference children cancer center; with TSC in the State of Rio de Janeiro from 2004 to 2019. The clinical and epidemiological data collected were described and a comparison was made between these two centers studied. Results: the sociodemographic characteristics found were similar to those described in the medical literature. Data related to treatment and follow-up, such as the use of chemotherapy, use of specific imaging tests, digital rectal examination, and outpatient follow-up, differed between the two centers studied. There was a 25% loss of follow-up. Conclusion: the characteristic of being a non-cancer center can interfere with the full application of the current protocol for the treatment of sacrococcygeal teratoma. The knowledge of the data of the studied cases can allow the optimization of the approach of the patients with this pathology and generate discussions about the integral application of the specific therapeutic protocol in the medical centers that are qualified for such treatment.

Postoperative Bowel and Urinary Dysfunction of Sacrococcygeal Teratoma

“…Although in this study there was no any case of urinary dysfunction and none of them send for urodynamic study , there is debate about whether asymptomatic patients should undergo technically challenging examinations such rectomanometry and video urodynamic investigations [7, 10,12,14]. The possibility of upper urinary tract injury necessitates a particular approach to urologic functional impairment.…”

“…Functional impairment's cause has not been determined with certainty. Tumors with a substantial and adherent intrapelvic component may cause surgical trauma, direct pressure on pelvic nerves and plexuses, and traction caused by compression of surrounding tissues [14].…”

“…Anorectal dysfunction typically only comes into play when it is contributing to psychological issues. These can be identified by a thorough history that takes into account the patient's age and by a straightforward physical exam that includes digital rectal palpation [14].…”