Presented at the Neonatal Society 2007 Autumn Meeting.
Tailor J, Roy PG, Hitchcock R, Grant H, Johnson P, Joseph VT, Lakhoo K
Department of Paediatric Surgery, John Radcliffe Hospital, Oxford OX39DU, UK
Background: Sacrococcygeal teratoma (SCT) is the commonest neonatal neoplasm. The outcome of antenatally and post-natally diagnosed SCT has been documented but few studies report the long term effects (1).
Aim: To determine the long term functional impairment after SCT excision over a fourteen year period in a single UK regional centre.
Methods: All patients with a SCT excised at the John Radcliffe Hospital in Oxford were retrieved from the Congenital Anomaly Register for Oxfordshire, Berkshire and Buckinghamshire (CAROBB) and internal pathology database. Patient clinical data were retrospectively and prospectively reviewed.
Results: Over a fourteen year period 18 patients had a histological diagnosis of SCT. Nine patients (50%) were born, seven (39%) were terminated and two (11%) were stillbirths. Of the nine patients who had SCT resection, four (44%) were antenatally diagnosed and 3 of these 4 patients with Altman type I-II lesions were born by elective caesarean section. Two patients had associated congenital anomalies which included ventricular septal defect, patent foramen ovale and congenital dislocation of the hip. Two patients had tumour haemorrhage that required urgent surgery, one of which suffered an intraoperative cardiac arrest secondary to hypovoleamic shock. There were no peri-operative deaths and alpha-fetoprotein levels normalised within 3 months after tumour resection. Median follow-up of patients was 30 months (range 6-132 months) with one patient lost to follow-up at 6 months (asymptomatic at the time). Three patients (33%) developed urological complications (two within one year of tumour resection) including two patients with neurogenic bladder dysfunction and one patient with detrusor sphincter dyssynergia.
Conclusion: Approximately one third of patients will develop major urological complications after resection of SCT. Routine ultrasonography in the first postoperative year after tumour resection may help to identify patients with neuropathic bladder at the early stage and predict late complications. Parents need to be aware of this potential long term complication during pre-natal counselling and the necessity for regular long-term follow-up.
References
1. Makin, E.C., et al., Outcome of antenatally diagnosed sacrococcygeal teratomas: single-centre experience (1993-2004). J Pediatr Surg, 2006. 41(2): 388-93.