Long-term functional sequelae of sacrococcygeal teratoma: a national study in The Netherlands.
BACKGROUND
Long-term functional sequelae after resection of sacrococcygeal teratoma (SCT) are relatively common. This study determines the incidence of these sequelae associated clinical variables and its impact on quality of life (QoL).


METHODS
Patients with SCT treated from 1980 to 2003 at the pediatric surgical centers in The Netherlands aged more than 3 years received age-specific questionnaires, which assessed parameters reflecting bowel function (involuntary bowel movements, soiling, constipation), urinary incontinence, subjective aspect of the scar, and QoL. These parameters were correlated with clinical variables, which were extracted from the medical records. Risk factors were identified using univariate analysis.


RESULTS
Of the 99 posted questionnaires, 79 (80%) were completed. The median age of the patients was 9.7 years (range, 3.2-22.6 years). There were 46% who reported impaired bowel function and/or urinary incontinence (9% involuntary bowel movements, 13% soiling, 17% constipation), and 31% urinary incontinence. In 40%, the scar was cosmetically unacceptable. Age at completion of the questionnaire, Altman classification, sex, and histopathology were not risk factors for any long-term sequelae. Size of the tumor (>500 cm3) was a significant risk factor for cosmetically unacceptable scar (odds ration [OR], 4.73; confidence limit [CL], 1.21-18.47; P = .026). Long-term sequelae were correlated with diminished QoL.


CONCLUSIONS
A large proportion of the patients with SCT have problems with defecation, urinary incontinence, or a cosmetically unacceptable scar that affects QoL. Patients who are at higher risk for the development of long-term sequelae cannot be clearly assessed using clinical variables.
Derikx
Joep P M
JP
Department of Surgery, University Hospital, PO Box 5800, Maastricht 6200 AZ, The Netherlands.
De Backer
Antoine
A
van de Schoot
Léon
L
Aronson
Daniel C
DC
de Langen
Zacharias J
ZJ
van den Hoonaard
Thelma L
TL
Bax
Nicolaas M A
NM
van der Staak
Frans
F
van Heurn
L W Ernest
LW
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D002921:Cicatrix / Q000453:epidemiology / Q000209:etiology / Q000523:psychology; D003248:Constipation / Q000453:epidemiology / Q000209:etiology; D004954:Esthetics; D005242:Fecal Incontinence / Q000453:epidemiology / Q000209:etiology / Q000523:psychology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D010386:Pelvic Neoplasms / Q000151:congenital / Q000453:epidemiology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D011788:Quality of Life; D012189:Retrospective Studies; D012307:Risk Factors; D012445:Sacrococcygeal Region; D012983:Soft Tissue Neoplasms / Q000151:congenital / Q000453:epidemiology / Q000601:surgery*; D011795:Surveys and Questionnaires; D017741:Survivors; D013724:Teratoma / Q000151:congenital / Q000453:epidemiology / Q000601:surgery*; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000453:epidemiology / Q000209:etiology / Q000523:psychology