The Children's Hospital of Philadelphia
What Families and Physicians Should Know About Teratomas — Surgery: Sacrococcygeal Teratoma (SCT)
Alan W. Flake, MD: Postnatal surgery for SCT requires fairly meticulous dissection to remove the tumor.
N. Scott Adzick, MD: For those tumors that have both an internal and an external component, it may be necessary to work both in the abdomen to control the blood supply to the large vascular tumor as well as working on the bottom.
Alan W. Flake, MD: The tumor can often be massive. It usually displaces the anus and rectum, and that's something that you have to be very careful to preserve, obviously. It also displaces the nerves and blood vessels as they come out of the pelvis. And so you have to be very careful because these structures are displaced and they may not be in their normal position, to meticulously stay on the capsule of the tumor and follow the tumor into the pelvis and up to its origin from the coccyx.
N. Scott Adzick, MD: The goal of the operation is to remove all of the tumor, to remove the tailbone because there's a recurrence risk if the coccyx is not removed because that's the location where the tumor arises from.
Alan W. Flake, MD: It's as high as 30 percent recurrence rate if you don't resect the coccyx. And so we resect the coccyx, we remove the entire tumor including the pelvic component, if necessary, and most of the time that will cure the baby from the SCT.
Lori J. Howell, RN: They'll also do a reconstruction of their buttocks area and have a nice scar formation so that you can actually tell that is there's definition to their bottom later on.
Victoria Dougherty, parent of Josephine: You're thinking, "Are there going to be any developmental problems?" Even down to, you know, is she going to feel bad in a bathing suit when she gets to be 14?
Alan W. Flake, MD: The cosmetic appearance of SCTs is something that may not be of great concern at the time, but in the long term for the children and the families, I think it's a very important consideration.
N. Scott Adzick, MD: The first obligation we have as pediatric surgeons is to resect the tumor completely, do as complete of a reconstruction as possible, and then to make things look as normal as possible, although that can't also be done in one setting.
Alan W. Flake, MD: What you normally try to do is preserve everything that's been distorted by the tumor, put it back together in an anatomic way, and most of the time you can have a fairly good cosmetic appearance with that.
N. Scott Adzick, MD: And it is necessary in some cases to do a scar revision for very large tumors, for instance.
Alan W. Flake, MD: There's still a scar there. There's no way to do this without a scar, but at least the contour of the area looks pretty normal.