title: Long-term functional sequelae of sacrococcygeal teratoma: a national study in The Netherlands.
abstract: 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.
authors.affiliation: Department of Surgery, University Hospital, PO Box 5800, Maastricht 6200 AZ, The Netherlands.
authors.forename: Joep P M
authors.initials: JP
authors.lastname: Derikx
authors.forename: Antoine
authors.initials: A
authors.lastname: De Backer
authors.forename: Léon
authors.initials: L
authors.lastname: van de Schoot
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Aronson
authors.forename: Zacharias J
authors.initials: ZJ
authors.lastname: de Langen
authors.forename: Thelma L
authors.initials: TL
authors.lastname: van den Hoonaard
authors.forename: Nicolaas M A
authors.initials: NM
authors.lastname: Bax
authors.forename: Frans
authors.initials: F
authors.lastname: van der Staak
authors.forename: L W Ernest
authors.initials: LW
authors.lastname: van Heurn
mesh_terms: 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