Operative Considerations in Pediatric Retroperitoneal Teratomas—A Review

Abstract

Background Retroperitoneal teratomas account for 5% of teratomas and occur predominantly in infants. The resection of these tumors has been variously reported as easy or difficult. This report presents a series of retroperitoneal teratomas and reviews the literature focusing on the relevant operative considerations in this tumor.

Methods A retrospective chart review from 1996 to 2011 identified five children with retroperitoneal teratomas. Clinical features, radiologic findings, operative details, and outcome were recorded. The literature was reviewed to identify operative complications for these tumors.

Results Out of the five patients, four were infants. The tumor was characterized by dense adhesions in all patients, and resection was complicated by gastric and common bile duct injury. Hiatal hernia repair was required in one and spillage was seen in two patients. One patient had a staged resection after birth with colostomy, vesicostomy, and eventual death on day 12 of life. Inferior vena cava (IVC) ligation was required in one. A total of four patients were well on long-term follow-up. Review of the literature revealed that computed tomography scan while being sufficient for diagnosing a retroperitoneal teratoma is often inadequate in delineating the vascular anatomy, which is usually distorted. The IVC and the mesenteric vessels may be inseparable and require ligation. Renal vessel injury is possible, leading onto ischemia and hypertension. The tumor may be intimately adherent to the viscera in the abdomen, making resection complicated. Adequate resection is possible and necessary for cure, but not always possible with clear resection margins. Late complications include recurrence, adhesions, and hypertension. The perioperative mortality is 0 to 8% and the complication rate is 50 to 100%.

Conclusion Surgical resection of retroperitoneal teratomas, while being the mainstay of treatment is challenging in view of its size, adhesions, and vascular distortion.

Keywords

teratoma - retroperitoneal teratoma - infant - operative complications

• References

• 1 Brodeur GM, Howarth CB, Pratt CB, Caces J, Hustu HO. Malignant germ cell tumors in 57 children and adolescents. Cancer 1981; 48 (8) 1890-1898
• 2 Gatcombe HG, Assikis V, Kooby D, Johnstone PA. Primary retroperitoneal teratomas: a review of the literature. J Surg Oncol 2004; 86 (2) 107-113
• 3 Barksdale Jr EM, Obokhare I. Teratomas in infants and children. Curr Opin Pediatr 2009; 21 (3) 344-349
• 4 De Backer A, Madern GC, Hazebroek FWJ. Retroperitoneal germ cell tumors: a clinical study of 12 patients. J Pediatr Surg 2005; 40 (9) 1475-1481
• 5 Luo CC, Huang CS, Chu SM, Chao HC, Yang CP, Hsueh C. Retroperitoneal teratomas in infancy and childhood. Pediatr Surg Int 2005; 21 (7) 536-540
• 6 Hayasaka K, Yamada T, Saitoh Y , et al. CT evaluation of primary benign retroperitoneal tumor. Radiat Med 1994; 12 (3) 115-120
• 7 Hart J, Mazrani W, Jones N, Kiely EM, Sebire NJ, McHugh K. Upper abdominal teratomas in infants: radiological findings and importance of the vascular anatomy. Pediatr Radiol 2008; 38 (7) 750-755
• 8 Okada T, Sasaki F, Onodera Y , et al. Multiple mesenteric teratomas: usefulness of spiral computed tomography with 3-dimensional reconstruction. J Pediatr Surg 2006; 41 (4) 868-871
• 9 Günther P, Schenk JP, Wunsch R, Tröger J, Waag KL. Abdominal tumours in children: 3-D visualisation and surgical planning. Eur J Pediatr Surg 2004; 14 (5) 316-321
• 10 Jones NM, Kiely EM. Retroperitoneal teratomas—potential for surgical misadventure. J Pediatr Surg 2008; 43 (1) 184-186 , discussion 187
• 11 Yeap BH, Zahari Z. Neonatal tumours in Malaysia: a call for heightened awareness. Pediatr Surg Int 2010; 26 (2) 207-212
• 12 Hunter CJ, Ford HR, Estrada JJ, Stein JE. Alpha-fetoprotein levels correlate with the pathologic grade and surgical outcomes of pediatric retroperitoneal teratomas. Pediatr Surg Int 2009; 25 (4) 331-336
• 13 Fueglistaler P, Gurke L, Stierli P , et al. Major vascular resection and prosthetic replacement for retroperitoneal tumors. World J Surg 2006; 30 (7) 1344-1349
• 14 Jones VS, Shun A. Is the inferior vena cava dispensable?. Pediatr Surg Int 2007; 23 (9) 885-888
• 15 Chaudhary A, Misra S, Wakhlu A, Tandon RK, Wakhlu AK. Retroperitoneal teratomas in children. Indian J Pediatr 2006; 73 (3) 221-223
• 16 Engel RM, Elkins RC, Fletcher BD. Retroperitoneal teratoma. Review of the literature and presentation of an unusual case. Cancer 1968; 22 (5) 1068-1073