G576(P) Sacrococcygeal teratoma: prenatal diagnosis to post-surgical follow up

Introduction Sacrococcygeal teratoma (SCT) is the most common neonatal tumour. Albeit perinatal and surgical complications have been extensively reported, the information regarding the natural history of SCT from prenatal diagnosis to post-surgical outcome beyond the neonatal period is limited. The aim of this study was to review the outcome in a cohort of newborn infants delivered over 15 years in a single tertiary centre in the UK following prenatal diagnosis to surgical resection and long-term follow-up. Methods Newborn infants with a prenatal diagnosis of SCT and delivered between 2004 and 2018 were identified from the hospital records. Following initial stabilisation, infants were transferred to a local surgical centre. Medical records in both centres were reviewed retrospectively for demographic information, tumour characteristics, perinatal status, surgical details and post-surgical complications. Results 19 cases of SCT were identified over 15 years (2.2:1 female-to-male ratio). Most were of Altman type II (68%) with mature histology (57.9%), mixed morphology (47%), and minimal or moderate vascularity (52.6%). No teratomas were malignant. In utero complications included polyhydramniosis (31.5%), high-output failure (26%) and bilateral hydronephrosis (10.5%). There was one perinatal death (related to immediate postnatal haemorrhage), however, no intrauterine demises or stillbirth noted. Average gestation at delivery was 34+6 weeks. Majority were delivered by elective C-section (58%). 52.6% of infants required support at birth which was associated more with male gender; larger, fast-growing and vascular tumours; presence of in utero complications, pre-term delivery and emergency C-section. The commonest surgical approach was prone (83%) with coccygectomy reported in 87.5%. 12.5% of cases were complicated by tumour spillage and incomplete resection. No recurrences noted. Long-term surgical complications were common and included gastrointestinal (62.5%), urological (37.5%), local (31%) and neurological/gait (18.8%). Surgical complications were higher with male gender, higher birthweight, delayed prenatal detection, larger size, fast growth, immature histology, feeding vessels and a greater AFP half-life. Furthermore, surgical complications were more frequent with in utero interventions. Conclusion Overall, SCTs had favourable prognosis with 95% survival rate. While poor condition at delivery was associated with known risk factors, long-term complications were not always predicted by early complications or poor condition at birth.