Surgical outcomes and complications of sacrococcygeal teratoma in neonates and infants: A systematic review and meta-analysis stratified by tumor characteristics and surgical approach.
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BACKGROUND: Sacrococcygeal teratoma (SCT) is the most common congenital tumor in neonates and infants. Despite advances in surgical management, reported outcomes remain heterogeneous, particularly regarding mortality, recurrence, and long-term functional complications. To synthesize contemporary evidence on surgical outcomes and postoperative complications of SCT in neonates and infants through a systematic review and meta-analysis. METHODS: A comprehensive search of PubMed/MEDLINE, Embase, Web of Science, Scopus, and Cochrane Central was conducted from January 2000 to February 2026 in accordance with PRISMA 2020 guidelines. Observational studies reporting postoperative outcomes of SCT resection in patients aged ≤12 months were included. Primary outcomes were overall mortality and tumor recurrence. Secondary outcomes included wound complications, urinary dysfunction, and bowel dysfunction. A random-effects meta-analysis of proportions was performed using the DerSimonian-Laird method with Freeman-Tukey double arcsine transformation. Heterogeneity was assessed using the I2 statistic. RESULTS: Twenty-one studies comprising 1399 patients met the inclusion criteria. The pooled overall mortality rate was 5% (95% CI 3-6%; I2= 0%). Tumor recurrence occurred in 9% of cases (95% CI 7-11%; I2= 22%). Wound complications were observed in 23% (95% CI 15-31%; I2= 86%). The pooled rates of urinary and bowel dysfunction were 15% (95% CI 10-20%; I2= 82%) and 21% (95% CI 14-29%; I2= 88%), respectively. Mortality demonstrated minimal heterogeneity, whereas complication outcomes showed substantial variability across studies. CONCLUSIONS: Surgical management of SCT in neonates and infants is associated with favorable survival outcomes but considerable morbidity and a notable risk of recurrence. These findings underscore the importance of meticulous surgical technique, routine coccygectomy, and prolonged multidisciplinary follow-up. Standardized outcome reporting and prospective studies are needed to improve risk stratification and optimize long-term care.