Operative management for sacrococcygeal teratoma diagnosed in utero

Background/Purpose: Sacrococcygeal teratomas (SCT) diagnosed in utero have been reported to be large and associated with high perinatal mortality rate . However, operative management including timing of operation after birth, combined abdominal approach for devascularization, and the position of the patients during resection is not well established. Methods: A retrospective review of 14 patients with SCT between 1978 and 19 99 was performed. To prevent massive bleeding during surgery, the authors u sed an abdominoperineal resection in the supine position after devasculariz ation. The patients' clinical and sonographic characteristics, prenatal out come, operative management, and postnatal outcomes were examined. Results: One fetus died in utero. Two patients died within a week, but no l ate death and no malignant degeneration were noted. A staged operation with devascularization was performed in 2 patients, and 1 death occurred. Surgi cal management was analyzed between survivors without massive bleeding at s urgery (n = 9) and others (n = 4). A significant difference was observed in the subgroup of tumor resection with devascularization or supine position and that of early resection with devascularization or supine position. Conclusions: Early resection using the abdominoperineal approach supported by close antenatal sonography may be preferable for a favorable outcome. Re section in the supine position after devascularization may have advantages of respiratory management, cardiac resuscitation, and bleeding prevention.