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Variability in Surveillance Strategies Following Resection of Sacrococcygeal Teratoma
Lindsay A Gil1, Maria E Knaus1, Joseph R Stanek2
1Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio.
Insights
Postoperative surveillance for sacrococcygeal teratoma (SCT) resection varies significantly. Further multi-institutional studies are needed to establish optimal surveillance strategies for detecting SCT recurrence.
Area of Science:
- Pediatric Surgery
- Surgical Oncology
- Developmental Biology
Background:
- Sacrococcygeal teratoma (SCT) is a common congenital tumor in infants.
- Current surveillance practices following SCT resection lack standardization.
- Understanding clinical characteristics and outcomes is crucial for guiding follow-up care.
Purpose of the Study:
- To describe clinical characteristics and outcomes of pediatric SCT resection patients.
- To examine current institutional surveillance practices for SCT recurrence detection.
- To compare surveillance strategies across different histopathologic subtypes.
Main Methods:
- Retrospective review of pediatric patients undergoing SCT resection (2010-2020).
- Data analysis included clinical characteristics, outcomes, and surveillance modalities.
- Nonparametric methods were used to compare surveillance strategies between histopathologic subtypes.
Main Results:
- Thirty-six patients (75% female) underwent SCT resection; 27 were mature teratomas, 8 immature, and 1 malignant.
- Median follow-up was 3.17 years; surveillance included clinic visits, AFP levels, and imaging.
- Patients with immature teratomas had more frequent AFP testing (P=0.001); two recurrences (5.6%) were noted, one in the malignant case.
Conclusions:
- Significant variation exists in postoperative surveillance practices for SCT.
- Recurrence was observed in one malignant case within the first year post-resection.
- Multi-institutional studies are essential to define optimal surveillance protocols for SCT recurrence.
Introduction:
Surveillance following sacrococcygeal teratoma (SCT) resection varies. The purpose of this study was to describe the clinical characteristics and outcomes of patients undergoing SCT resection and examine current institutional practices to detect recurrence.
Methods:
A single-institution retrospective review of children who underwent resection of an SCT from January 1, 2010 to December 31, 2020 was performed. Data were summarized and surveillance strategies compared between histopathologic subtypes using nonparametric methods.
Results:
Thirty six patients (75.0% female) underwent SCT removal at a median age of 8 d. Histopathology revealed 27 mature teratomas (75.0%), eight immature teratomas (22.2%), and one malignant germ cell tumor (2.8%). Median postoperative follow-up was 3.17 y (interquartile range [IQR]: 2.31-4.38 y). Patients had a median of 2.32 clinic visits per year (IQR: 2.00-2.70), alpha-fetoprotein levels were obtained at a median of 2.01 times per year (IQR: 0-1.66), and surveillance imaging was performed at a median of 2.31 times per year (IQR: 0-2.84). Patients with immature teratomas had alpha-fetoprotein laboratories obtained more frequently than patients with mature teratomas (3.10 times/year versus 0.93 times/year, P = 0.001). There was no significant difference in the number of imaging studies obtained between groups. Two patients (5.6%) developed recurrence, which were identified on magnetic resonance imaging at 191 and 104 d postresection, respectively.
Conclusions:
Postoperative surveillance practices varied widely. Recurrence was noted in a single malignant case in the first year following resection. Multi-institutional studies are needed to determine the optimal surveillance strategy to detect recurrence of SCT.
