Compromise of tumor tissue integrity during the treatment of teratomas in newborns

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Introduction . When treating germ-cell tumors (teratomas) in newborns it is not always possible to avoid breaking of continuity of the tumoral tissue (such as capsule rupture or spillage of the cysts). There exist several procedures described and used, requiring intentional disruption of tumoral integrity: intrauterine punctures of large cysts, EXIT-procedures. The question concerning possible increase of tumor recurrence risk in such cases remains disputable up to date. The aim of study – based on 19 years’ experience of two clinics, to assess incidence of tumoral rupture cases during treatment of teratomas in newborns, analyzing their causes, possibilities of prophylaxis, and prognostic value. Materials and methods . A retrospective analysis of medical documentation and follow-up data was performed concerning 75 newborns with teratomas from one surgical and one oncological clinic in Saint Petersburg during a period of 2005–2023. Patients with teratomas of different localization were operated on the day of life 0–14, from whom 8 subsequently developed a local recurrence within 2–18 months after surgery. The fact of tumoral rupture was established in 25 (33.3 %) children: with sacrococcygeal – 23 (92 %), neck – 1 (4 %), and abdominal localization – 1 (4 %). Those cases included an intrauterine cyst puncture (n = 1), partial resection of a giant sacrococcygeal teratoma during an EXIT-procedure (n = 2), rupture of tumoral membranes during delivery (n = 3), intentional puncture or unwilling spillage of the cysts during surgery (n = 24), 4 babies having a combination of several variants of tumoral rupture at one time. After exclusion of cases with unknown follow-up data total of 63 patients were investigated: 22 with tumoral rupture (including 3 with subsequent relapses) and 41 without tumoral rupture (including 5 with subsequent relapses). Statistical assessment was provided. Results . The predominant variant appeared to be intraoperative rupture of teratomas: 24 (32 %) cases, among them 83 % representing unintentional spillage of the cysts because of difficulties of visualization of their thin walls during dissection. The statistical analysis performed revealed no correlation between tumoral rupture and subsequent recurrence of teratoma in our study (p = 1.0; Fisher’s exact test). Conclusion . The prognostic value of tumoral rupture and spillage in neonatal teratomas treatment deserves, perhaps, some further interpretation, requiring more investigation using larger cohorts of patients. At the same time, the results of current study could probably serve to justify some antenatal interventions, EXIT-procedures, as well as intentional cyst punctures in certain challenging cases during treatment of teratomas in newborns.