Prognostic Appraisal of Sacrococcygeal Teratoma- Authors Experience and Review of literature

Background: Sacrococcygeal teratoma is associated with malformations which may have a bearing on the outcomes of these patients. The study aimed to present its varied clinical presentation, management, and outcome analyses in our geographical region. Methods: A prospective descriptive observational study was carried out on a cohort of paediatric patients with sacrococcygeal teratoma. All consecutive patients admitted and managed by the authors in a tertiary care teaching institute from 2011 to 2024 were studied. Patients were followed up for at least one year after surgical intervention. Results: There were 53 patients (F: M=1:2.18). The median age at presentation was 12 days. Forty (74.47%) patients presented with swelling lower back. The patients were Altman I - 23/53 (43.39%), Altman II - 17/53 (32.08%), Altman III - 5/53 (9.43%), and Altman IV - 8/53 (15.09%). Associated major malformations were present in 9 (16.98%) patients; anorectal malformation- 4 (7.55%) patients; 3 (5.66%) were consistent with Currarino syndrome. Tumour excision and coccygectomy were performed in 52 (98.11%) patients. Histopathology revealed mature teratoma in 41/52 (78.85%), immature teratoma in 9/52 (17.31%), and malignant tumours in 2/52 (3.85%) patients. Early postoperative complications were seen in 11/52 (21.15%) patients, including 3 (5.77%) deaths. Early survival (within 3 months) was 48/53 (90.57%). Late complications (within 1 year) were seen in 8/35 (22.86%) patients. Conclusion: Most of the sacrococcygeal teratomas are benign (mature); immature and especially malignant tumours are often seen around and beyond infancy. Mortality is due to associated major malformations, sepsis, sclerema, and tumour recurrence.