APSA papers
Retroperitoneal teratomas—potential for surgical misadventure

https://doi.org/10.1016/j.jpedsurg.2007.09.041Get rights and content

Abstract

Background

Retroperitoneal teratoma (RPT) is a relatively uncommon tumor in children. This study concerns 6 children with RPT that involved surrounding structures and required rather extensive operative procedures to successfully excise the lesions.

Methods

A review of RPT in children encountered at a single institution over an 8-year period by a single surgeon was carried out. Age at presentation, sex, operative findings, surgical management, and outcomes were evaluated.

Results

Four of the 6 patients were girls, and 5 were younger than 6 months at diagnosis. All of the tumors enveloped and displaced the aorta and vena cava, 1 involved the stomach wall, 2 others displaced the renal vessels, and 1 the portal vein. Extensive resection including major vessel ligation was necessary for complete excision. All the tumors were benign, but 1 recurred. There were no deaths; however, 2 children have persistent hypertension.

Conclusions

The operative management of RPTs may be complex and challenging. Despite their benign nature, the lesions can attenuate and surround major vessels, making resection difficult. Ligation of major vessels when necessary is tolerated well and may be required for complete tumor excision.

Section snippets

Aim

We wish to report our experience with these tumors, specifically concentrating on the anatomy of the tumors encountered at operation.

Methods

A retrospective review of the operative findings in 6 patients who underwent resection of RPTs by the senior author (EK) since 1999 was carried out.

Results

Four of the 6 children were girls, and 5 were 6 months or younger at the time of operation (Table 1). All 6 tumors enveloped and displaced the inferior vena cava (IVC) and the abdominal aorta. The major branches of these vessels were often so attenuated and thinned that they appeared insignificant. In addition, renal arteries frequently were displaced posteriorly, whereas the corresponding veins ran over the anterior aspect of these tumors.

In the youngest child, aged 3 weeks, the tumor arose

Discussion

Few pediatric surgeons will encounter large numbers of children with RPTs. Recent reports in the literature contain small numbers. Luo et al [4] reported 10 patients who underwent excision of this tumor at a single institution over a 5-year period. Contrary to our experience, they found surgical excision easy. This is explained by the lack of adherence of the tumors to the retroperitoneal organs except by areolar tissue—so-called “unattached retroperitoneal tumors” as described by Hansmann and

References (7)

  • H.G. Gatcombe et al.

    Primary retroperitoneal teratomas: a review of the literature

    J Surg Oncol

    (2004)
  • A.J. Davidson et al.

    Mature teratoma of the retroperitoneum: radiologic, pathologic, and clinical correlation

    Radiology

    (1989)
  • D. Tapper et al.

    Teratomas in infancy and childhood. A 54-year experience at the Children's Hospital Medical Center

    Ann Surg

    (1983)
There are more references available in the full text version of this article.

Cited by (0)

Presented at the 38th annual meeting of the American Pediatric Surgical Association, Orlando, Florida, May 24-27, 2007.

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