title: Surgical outcomes in adults with benign and malignant sacrococcygeal teratoma: a single-institution experience of 26 cases.
abstract: BACKGROUND
  Adult sacrococcygeal teratomas are rare, and limited data exist on their management and outcomes following surgery.
  
  
  OBJECTIVE
  The aim of this study was to review the outcomes in adult patients undergoing surgery for sacrococcygeal teratomas.
  
  
  METHODS
  A retrospective review of our prospectively maintained surgical pathology and tumor registries was conducted.
  
  
  METHODS
  This study was conducted at the Mayo Clinic in Rochester. Information was collected on patients treated between 1980 and 2013.
  
  
  METHODS
  A total of 26 patients with sacrococcygeal teratoma were identified (19 female), with a median age of 37.5 years. Malignancy was seen in 5 patients.
  
  
  METHODS
  Data on demographics, clinical presentation, tumor pathology, adjuvant therapy, surgical approach, surgical margins, use of preoperative biopsy, radiological investigations, morbidity, mortality, and local recurrence was collected. Complications were assessed by using the Clavien-Dindo system of classification.
  
  
  RESULTS
  Patients most commonly presented with pelvic pain (n = 16) and/or a palpable mass (n = 15). On radiology, 8 lesions were purely cystic, 14 were mixed, and 4 were solid; teratoma was suspected as a diagnosis in 8 patients. Preoperative biopsy (13 patients) had 100% concordance with final pathology. Median tumor size was 6 cm, and the surgical approach was posterior only (n = 15), anterior only (n = 5), and combined anterior-posterior (n = 6). Of 5 patients with malignancy, 3 died of recurrent disease.
  
  
  CONCLUSIONS
  Limitations of this study include the small number of patients, the long study period, and the heterogeneous nature of these tumors.
  
  
  CONCLUSIONS
  Presacral teratomas require multidisciplinary management and have a risk of malignant transformation. They are more common in females, and the majority are intrapelvic in location in adults. We recommend clinical evaluation, radiological investigation, and image-guided biopsy in all suspicious presacral lesions. A treatment algorithm has been designed to improve the management of these rare tumors.
authors.affiliation: 1Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota 2Department of Surgery, Mayo Clinic, Rochester, Minnesota 3Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota 4Division of Pediatric Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Simpson
authors.forename: Kevin B
authors.initials: KB
authors.lastname: Wise
authors.forename: Amit
authors.initials: A
authors.lastname: Merchea
authors.forename: John C
authors.initials: JC
authors.lastname: Cheville
authors.forename: Christopher
authors.initials: C
authors.lastname: Moir
authors.forename: David W
authors.initials: DW
authors.lastname: Larson
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Dozois
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000175:diagnosis / Q000601:surgery*; D003050:Coccyx / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012447:Sacrum / Q000601:surgery*; D013724:Teratoma / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult