Optimizing surveillance strategies for sacrococcygeal teratoma: A Midwest pediatric surgery consortium multi-institutional study

Sacrococcygeal teratomas (SCTs) are the most common germ cell tumors in neonates and infants. While typically benign, SCTs carry an undefined risk of recurrence and malignant transformation, making post-resection surveillance critical. However, no consensus guidelines exist to direct post-resection surveillance. We conducted a multi-institutional retrospective cohort study across 11 pediatric institutions in the Midwest Pediatric Surgery Research Consortium. The study included patients 18 years or younger who underwent SCT resection from January 2010 to December 2020, excluding those with Currarino syndrome. The primary outcome was SCT recurrence, assessed via clinical exams, imaging, and tumor markers. Secondary outcomes included recurrence histology and surveillance practices. Cox proportional hazards modeling evaluated recurrence risk factors. Of the 178 patients, 10% experienced recurrence during a median follow-up period of 2.88 years (IQR: 1.52, 4.80). Overall recurrence-free survival for the entire cohort was 93.7%, 88.8%, and 88.8% at 1, 3, and 5 years, respectively. Malignant histopathology was the only factor significantly associated with recurrence (HR 5.83, p = .014). The timing of SCT diagnosis, completeness of resection, and Altman classification were not significantly associated with recurrence. Surveillance strategies varied significantly across institutions, with no standardized protocol for follow-up. The majority of recurrences occurred within the first 3 years post-resection, with malignant histopathology being the strongest predictor. For lower risk tumors (mature and immature teratomas), a minimum of 3 years of surveillance, including imaging, tumor markers, and clinical exams, is recommended. Standardized surveillance protocols could improve consistency and early detection.