Experience with vascular control before excision of giant, highly vascularsacrococcygeal teratomas in neonates

Sacrococcygeal teratomas (SCT) are the most common neoplasms in newborns wi th a reported occurrence of 7 in 35,000 live births. Highly vascularized tu mors in which the ratio of tumor weight to patient weight approaches 1:1 ar e frequently associated with hyperdynamic states, prenatal hydrops, placent amegaly, postnatal high-output cardiac failure, and carry a high perinatal mortality rate. Operative management of giant, highly-vascular sacrococcyge al teratomas in neonates can be complicated by life-threatening hemorrhage. Laparotomy, control of the aorta, and the arterial blood supply to these t umors before resection has been advocated as a safer alternative. The autho rs report their experience with three infants successfully treated using th is approach. Hemodynamic stability was maintained during the operations. Al l tumors were resected successfully. The patients are alive without evidenc e of recurrence, 8.5 months to 18 months (average, 14.3 months) after the o peration. Alpha-fetoprotein levels dropped to normal range after the remova l of SCT and have remained normal in follow-up. Vascular control before exc ision of giant, highly-vascular SCT in neonates is safe, decreases intraope rative blood loss, and postoperative morbidity. J Pediatr Surg 33:1840-1842 . Copyright (C) 1998 by W.B. Saunders Company.