De Backer Antoine, Madern Gerard C, Hakvoort-Cammel Friederike G A J, Haentjens Patrick, Oosterhuis J Wolter, Hazebroek Frans W J
Section of Pediatric Surgery, Academic Hospital, Free University of Brussels, Laarbeeklaan, B-1090 Brussels, Belgium.
J Pediatr Surg. 2006 Jan;41(1):173-81; discussion 173-81. doi: 10.1016/j.jpedsurg.2005.10.022.
The aim of this study was to explore effects of (1) histological involvement of resection margins with microscopic residue, (2) incomplete removal of coccyx, and (3) tumor spillage on recurrence and on survival in children operated upon for sacrococcygeal teratoma (SCT).
Retrospective review of 70 patients treated between 1960 and 2003.
Fifty-four girls and 16 boys presented with SCT diagnosed prenatally (12), at birth (37), or later (21). Thirty-six percent of tumors were Altman type I, 27% type II, 18% type III, and 18% type IV. Histologically, mature teratoma was observed in 48 patients, immature teratoma in 11, yolk sac tumor (YST) in 9, embryonal carcinoma in one, and mixed tumor in one. Eighty-four percent of patients solely underwent surgical extirpation. Six (8.5%) patients died. However, mortality for the group of 42 patients treated during the past 15 years was as low as 2.5%. Tumor recurrence was observed in 5 patients, 2 of whom died. Of 3 patients with initially mature teratoma, 1 showed local immature recurrence and 2 malignant recurrences. One of the latter died. Of 2 patients with initially immature teratoma grade I, one relapsed with a benign lesion and one with YST leading to death. Possible eliciting factors had been demonstrated in 3 patients. Histological analysis of resection margins showed tumoral involvement in 11 patients (and also in one patient after resection of a recurrent tumor). Only one of those with YST focus in the resection margin showed recurrence. Intraoperative tumor spillage presented in 2 patients, who both died of metastatic disease. Spillage of tumoral cyst fluid occurred in 6, none developed recurrence. One of 5 patients whose coccyx had not been removed died of metastatic disease. One with immature teratoma developed a benign recurrent tumor. The other 3 showed no recurrence.
Microscopic involvement of the resection margins of mature or immature SCT is rarely associated with recurrence, provided there are no YST foci in the resection margins. A conservative attitude then appears to be justified. Spillage of cyst fluid was never associated with recurrence, unlike spillage of tumor and absence of removal of coccyx.
本研究旨在探讨（1）切除边缘存在微小残留的组织学累及情况、（2）尾骨未完全切除、（3）肿瘤溢出对接受骶尾部畸胎瘤（SCT）手术的儿童复发及生存的影响。
回顾性分析1960年至2003年间接受治疗的70例患者。
54例女孩和16例男孩患有SCT，其中12例在产前确诊，37例在出生时确诊，21例在出生后确诊。36%的肿瘤为奥特曼I型，27%为II型，18%为III型，18%为IV型。组织学检查显示，48例患者为成熟畸胎瘤，11例为未成熟畸胎瘤，9例为卵黄囊瘤（YST），1例为胚胎癌，1例为混合性肿瘤。84%的患者仅接受了手术切除。6例（8.5%）患者死亡。然而，在过去15年中接受治疗的42例患者组的死亡率低至2.5%。5例患者出现肿瘤复发，其中2例死亡。在最初为成熟畸胎瘤的3例患者中，1例出现局部未成熟复发，2例出现恶性复发。后者中有1例死亡。在最初为I级未成熟畸胎瘤的2例患者中，1例复发为良性病变，1例复发为YST并导致死亡。3例患者显示出可能的诱发因素。切除边缘的组织学分析显示11例患者（以及1例复发性肿瘤切除后的患者）存在肿瘤累及。切除边缘有YST灶的患者中只有1例出现复发。2例患者术中出现肿瘤溢出，均死于转移性疾病。6例出现肿瘤囊肿液溢出，均未发生复发。5例未切除尾骨的患者中有1例死于转移性疾病。1例未成熟畸胎瘤患者出现良性复发性肿瘤。其他3例未出现复发。
如果切除边缘没有YST灶，成熟或未成熟SCT切除边缘的微小累及很少与复发相关。那么采取保守态度似乎是合理的。与肿瘤溢出和未切除尾骨不同，囊肿液溢出从未与复发相关。
