Techniques available for the management of massive sacrococcygeal teratomas

Abstract

An infant born in the 34th week of gestation weighing 5,355 g with a massive sacrococcygeal (SC) tumor was delivered by elective cesarean section. An ultrasonographic examination showed solid and cystic components in the tumor. Resection was successfully undertaken with insertion of a Nélaton catheter into the rectum to avoid unnecessary impairment of the viscera. The tumor weighed 2,380 g, measured 25 x 14 x 11 cm, and was clinicopathologically diagnosed to be a SC teratoma. This experience and other publications show that several considerations including control of hemorrhage and coagulopathies, visceral protection, and avoidance of wound infection are necessary to facilitate the surgical management of massive SC tumors. Several suggestions are made concerning the pre- and intraoperative management of this rare tumor.

Complications with massive sacrococcygeal tumor resection on a premature neonate

“…After the tumor was resected, the patient improved drastically. The main causes of death during resection of large SCTs include hemorrhage, hypothermia, coagulopathy, extensive transfusion with blood products causing electrolyte abnormalities, and inability to provide enough cardiopulmonary support during the intraoperative manipulation of the tumor [3].…”

“…Open fetal surgery, endoscopic laser ablation, and radiofrequency ablation are also being used to excise these tumors. Predictors of poor outcome include diagnosis before 20 weeks gestation, delivery before 30 weeks, development of hydrops, low birth weight, Apgar score of less than 7, malignant histotypes, polyhydramnios, and placentomegaly [2,3].…”

Giant, highly vascular sacrococcygeal teratoma: Report of its excision using the ligasure vessel sealing system

“…To the best of our knowledge, there are 8 cases of GHV-SCT in the literature in whom devascularization was performed before tumor excision using either ligation of the median sacral artery/internal iliac arteries or an aortic snare technique. [4][5][6][7][8][9] There is one report of excision using extracorporeal membrane oxygenation and hypothermic hypoperfusion. 10 A GHV-SCT must be excised using one of the above-mentioned techniques; otherwise, massive life-threatening bleeding is inevitable.…”

Teratoma sacrococcígeo: relato de três casos

“…Concluíram que não foram obtidos resultados prognósticos significativos no tocante ao estadiamento tumoral, extensão de metástases, extensão ao osso e níveis de alfa-fetoproteína. Durante a cirurgia são recomendadas hemostasia adequada, controle de possível coagulopatia existente, proteção visceral e profilaxia contra infecção no sítio operatório.As complicações cirúrgicas incluem infecção da ferida operatória, atonia vesical e infecções do trato urinário 27 .A malignidade tumoral consiste na maior causa de morte, estando o procedimento cirúrgico isento de influência direta sobre o prognóstico imediato no pós-operatório 28 .…”