Mature cystic sacrococcygeal teratoma in adults with digestive system symptoms: Analysis of 28 cases

BACKGROUND

Mature cystic sacrococcygeal teratoma (SCT) is exceedingly rare in adults, with limited clinical studies and literature available. This study examined the clinical outcomes of 28 adult patients with mature cystic SCT treated surgically, aiming to provide a foundation for optimizing surgical strategies for this rare condition.

AIM

To retrospectively evaluate the clinical effectiveness of surgical treatment for mature cystic SCT in adults with digestive system symptoms.

METHODS

The clinical data of 28 adult patients with mature cystic SCT, admitted to the Provincial Hospital of Shandong First Medical University between January 2018 and November 2024, were retrospectively analyzed. All patients underwent surgical resection. The analysis included evaluation of surgical methods, intraoperative sacrococcygeal resection, excessive intraoperative hemorrhage (≥ 400 mL), postoperative complications such as intestinal fistula and sacrococcygeal incision necrosis, and tumor recurrence. The patients were then divided into Group A (n = 5, laparoscopicassisted anterior approach), Group B (n = 10, posterior approach), and Group C (n = 13, combined laparoscopic and posterior approach) based on the surgical modality used, and comparative analyses of postoperative complications and recurrence were conducted through controlled studies. Additionally, the samples were divided into Group E (n = 21, sacrococcygeal resection group) and Group F (n = 7, sacrococcygectomy group) independently according to whether sacrococcygectomy was performed or not, to analyze the relationship between sacrococcygectomy and tumor recurrence. In addition, the patient's postoperative recovery of digestive system function was discussed.

RESULTS

Surgical resection was completed in all the 28 patients, and postoperative pathology showed mature cystic teratoma in all of them. Of the 28 cases included, five were managed via an anterior approach assisted by laparoscopy, 10 via a posterior approach, and 13 via a combination of laparoscopic and posterior approach. Postoperative complications included three cases of enterocutaneous fistula and eight cases of localized necrosis at the sacrococcygeal incision site. All other patients recovered uneventfully. During follow-up, one patient succumbed to retroperitoneal metastasis 10 months after surgery, and four experienced recurrence between 6 and 24 months. Among these, three patients who had not undergone sacrococcygeal bone resection were successfully treated with reoperation, showing no recurrence to date. The remaining patients experienced favorable recovery without recurrence. In addition, there was no statistically significant difference among the three different surgical approaches in intraoperative bleeding ≥ 400 mL, intestinal fistula, sacrococcygeal incision necrosis, and recurrence rate (P > 0.05). However, there was a statistically significant difference in tumor recurrence between the patients who underwent sacrococcygeal resection and those who did not (P < 0.05).

CONCLUSION

The surgical approach for mature cystic sacrococcygeal teratoma in adults should be individualized based on tumor characteristics, including location, size, local invasion, and prior abdominopelvic surgical history. Sacrococcygeal resection is strongly recommended when feasible, and meticulous care of the incision site is crucial to prevent complications. In the perioperative period, clinicians should be concerned with the management of gastrointestinal function of patients, including preoperative intestinal preparation, postoperative gastrointestinal dynamics regulation, rational dietary guidance, and rehabilitation training, in order to promote the recovery of digestive system function.