Mature cystic sacrococcygeal teratoma in adults: A single-center study.
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BACKGROUND: Adult sacrococcygeal teratoma (SCT) is extremely rare in clinical practice, with most cases manifesting as mature cystic types. Given the scarcity of clinical studies and literature on this topic, standardized surgical guidelines for adults are notably absent, and current treatment strategies are predominantly derived from pediatric surgical practices. Furthermore, data on surgical outcomes and risk factors for postoperative dysfunction or recurrence in adult patients remain limited. Continued research on tumor treatment modalities and risk factors is still warranted. AIM: To assess surgical outcomes and identify risk factors for dysfunction and recurrence in adult mature cystic SCTs. METHODS: We conducted a retrospective analysis of 64 adult patients with mature cystic SCT who received surgical treatment at Shandong Provincial Hospital Affiliated to Shandong First Medical University, from January 2005 to December 2020, ensuring all had complete clinical and follow-up data. We compared the clinical outcomes of three different surgical approaches: Laparoscopic-assisted anterior (Type A), posterior (Type B), and combined laparoscopic-posterior (Type C), evaluating them through perioperative indicators. Univariate and multivariate logistic regression analyses were performed to determine risk factors for postoperative dysfunction and tumor recurrence. RESULTS: The study incorporated 64 patients, all of whom had been pathologically confirmed to have mature cystic SCTs. The clinical efficacy in adult mature cystic SCTs was not significantly impacted by the various surgical approaches employed. Maximum tumor diameter of 10 cm or more, Altman classification of type III/IV, and intraoperative blood loss of 400 mL or greater were risk factors for postoperative dysfunction (anorectal dysfunction, urinary dysfunction and lower extremity motor dysfunction). The sacrococcyx being left unresected was determined to be an independent risk factor for tumor recurrence. CONCLUSION: Surgical approach does not affect outcomes; larger tumors, advanced Altman type, blood loss, and unresected sacrococcyx increase risks of dysfunction and recurrence.