Surgical risk factors of retroperitoneal teratoma resection in children

Retroperitoneal teratoma is uncommon and carries considerable surgical risks. Some preoperative clinical and radiographic features could be predictive of surgical complication risk. We aimed to identify surgical risk factors that predicted perioperative complications.

Childhood retroperitoneal teratoma cases operated on at Guangzhou Women and Children's Medical Center were retrospectively reviewed. Demographic features; clinical, laboratory, radiographic, and intraoperative findings; perioperative complications; and pathology results were assessed.

Between May 2000 and December 2017, 152 childhood retroperitoneal teratomas were resected from 102 female patients (median age 5.75 months). Sixty-three patients (41%) experienced perioperative complications (79 intraoperative and 5 postoperative), including kidney excision (4 patients) and adrenal gland excision (1 patient). Among 113 patients with preoperative computed tomography/magnetic resonance images, 112 (99%), 111 (98%), and 113 (100%) demonstrated artery, vein, and organ distortion, respectively, and 28 (25%) had vessels encased by tumors. Patients with perioperative complications had more veins and organs distorted by tumors. In multivariate analysis, the numbers of vessels encased and organs distorted by tumors were significantly associated with perioperative complications (odds ratio = 1.45 and 1.69, 95% confidence interval: 1.00-2.10 and 1.19-2.41, respectively).

Retroperitoneal teratoma resection has a high perioperative complication rate. Teratomas encompassing the vasculature and distorting organs were associated with increased surgical risk. Additional studies aiming to better define the surgical approach to retroperitoneal teratoma are warranted.

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