Surgical outcomes in adults with benign and malignant sacrococcygeal teratoma: A single-institution experience of 26 cases

BACKGROUND: Adult sacrococcygeal teratomas are rare, and limited data exist on their management and outcomes following surgery. OBJECTIVE: The aim of this study was to review the outcomes in adult patients undergoing surgery for sacrococcygeal teratomas. DESIGN: A retrospective review of our prospectively maintained surgical pathology and tumor registries was conducted. SETTING: This study was conducted at the Mayo Clinic in Rochester. Information was collected on patients treated between 1980 and 2013. PATIENTS: A total of 26 patients with sacrococcygeal teratoma were identified (19 female), with a median age of 37.5 years. Malignancy was seen in 5 patients. MAIN OUTCOME MEASURES: Data on demographics, clinical presentation, tumor pathology, adjuvant therapy, surgical approach, surgical margins, use of preoperative biopsy, radiological investigations, morbidity, mortality, and local recurrence was collected. Complications were assessed by using the Clavien-Dindo system of classification. RESULTS: Patients most commonly presented with pelvic pain (n = 16) and/or a palpable mass (n = 15). On radiology, 8 lesions were purely cystic, 14 were mixed, and 4 were solid; teratoma was suspected as a diagnosis in 8 patients. Preoperative biopsy (13 patients) had 100% concordance with final pathology. Median tumor size was 6 cm, and the surgical approach was posterior only (n = 15), anterior only (n = 5), and combined anteriorposterior (n = 6). Of 5 patients with malignancy, 3 died of recurrent disease. LIMITATIONS: Limitations of this study include the small number of patients, the long study period, and the heterogeneous nature of these tumors. CONCLUSION: Presacral teratomas require multidisciplinary management and have a risk of malignant transformation. They are more common in females, and the majority are intrapelvic in location in adults. We recommend clinical evaluation, radiological investigation, and image-guided biopsy in all suspicious presacral lesions. A treatment algorithm has been designed to improve the management of these rare tumors.