Management strategies and long-term outcomes of sacrococcygeal teratoma in neonates: A 30-patient cohort study

Abstract Background Sacrococcygeal teratoma (SCT) is the most common congenital tumor in neonates. Complete surgical resection with coccygectomy remains the cornerstone for the treatment. This study aimed to analyze the diagnosis, management strategies, mortality, and long-term outcomes of neonatal patients with SCT. Methods This retrospective cohort study was conducted on 30 neonates (diagnosed within the first 28 days of life) between 2015 and 2025 at SKIMS, Srinagar, India. The collected data included demographics, diagnostics, tumor characteristics, surgical details, histopathology, complications, mortality, and long-term outcomes of neonates operated for SCT. The sample size calculation demonstrated adequate power for the outcome analysis. Results The cohort comprised 22 females and eight males (ratio 2.75:1). A prenatal diagnosis was achieved in 20 patients (66.7%). The median age at diagnosis was 2 days (range: 1–28 days). According to the Altman classification, Type I tumors were the most common (46.7%), followed by type II (26.7%), type III (20%), and type IV (6.7%) tumors. The median age at surgery was 7 days. The posterior approach was used in 73.3% of the cases, and the combined abdominosacral approach was used in 26.7%. Histopathologically, mature teratomas were found in 73.3%, immature teratomas in 20%, and malignant teratomas in 6.7%. Complete resection was achieved in 93.3% of the patients. Postoperative complications occurred in 40% of the patients. Two deaths occurred (6.7% mortality): one perioperative death from high-output cardiac failure and one late death from treatment-resistant malignant disease. At a median follow-up of 48 months, four recurrences (13.3%) occurred. The overall survival was 96.7% at 1 year and 93.3% at 2 and 5 years, while the disease-free survival was 96.7% at 1 year and 83.3% at 2 and 5 years. Conclusion Neonatal SCT has an excellent prognosis with appropriate surgical management. Type III tumors, large size, high-output cardiac failure, and malignant histology are high-risk features that require intensive management.