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

Infographic · Jan 2026 · 1 min read

In brief

Multi-institutional study of 178 pediatric SCT patients found 10% recurrence rate over median 2.88-year follow-up, with malignant histopathology as the only significant predictor. Most recurrences occurred within 3 years post-resection. Authors recommend minimum 3-year surveillance for lower-risk tumors using imaging, tumor markers, and clinical exams.

Written by the GCMD Library team from the infographic.

A four-panel medical illustration arranged in a 2x2 grid showing progressive surgical steps. Each panel contains a detailed anatomical cross-section of the lower digestive tract in muted pink and beige tones, with surgical instruments and anatomical structures clearly delineated. Blue text labels and arrows indicate key anatomical landmarks and surgical actions.

Shachi Srivatsa, Lindsay Gil , Yueran Zhang , Beth Rymeski , Amelia Gavulic , Grace Mak , Sindhu V Mannava , Troy A Markel, Matthew P Landman , Dave R Lal , Jennifer Schuh , Devashish Joshi , Brianna Spencer , Samir Gadepalli , Seth D Goldstein , Mark Ranalli , Kyle J Van Arendonk , Peter Minneci , Jennifer H Aldrink

Abstract

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.

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