Diagnosis,Treatment And Prognosis Of Primary Retroperitoneal Teratoma In Adult

Objective:To investigate the clinical features,diagnosis and treatment of primary retroperitoneal teratoma in adults,and to analyze the related factors affecting its prognosis.Methods:50 cases of retroperitoneal teratoma in Qingdao University affiliated Hospital from January 2001 to November 2018 were selected by digital case retrieval system of affiliated Hospital of Qingdao University.The patients were followed up.The data were retrospectively analyzed,and the clinical characteristics,diagnosis and surgical methods of retroperitoneal teratoma were summarized.The related factors affecting the recurrence and prognosis of retroperitoneal teratoma were analyzed.Results:Of the 50 patients,10（20.0%）were male and 40（40.0%）were female.The ratio of men to women is 1 to 4.The average age was（41.9±14.4）years,and the median age was 43 years（Age 16 to 75）.49 cases（98.0%）were benign,1 case（2.0%）was malignant,and the ratio of benign to malignant was 49%.42%of the patients were found by simple physical examination in the first visit（21/50）.36%（18/50）had pain in the tumor site,24%（12/50）had self-touching masses,18%（9/50）had changed defecation,and 8%（4/50）had urinary system symptoms.Numbness and pain in lower extremities accounted for4%（2/50）.The correct rate of preoperative imaging diagnosis was 56%.The tumors were located in 64%（32/50）of the pelvic sacrococcygeal region and 36%（18/50）in the abdomen.All 50 patients were followed up for 3²15 months with a median follow-up time of 60.5 months.As of the follow-up period,7 cases recurred,the recurrence rate was14.0%.The recurrence time ranged from 7 to 96 months after operation,the average recurrence time was 37.1 months,and the median recurrence time was 24 months.The factors related to the recurrence of retroperitoneal teratoma were analyzed byc^（17）test or Fisher accurate probability method.The results showed that the patient’s age（P=0.012）and the residual tumor（P=0.002）was associated with postoperative recurrence（P<0.05）.On the other hand,the sex of the patient（P=1.000）,the diameter of the tumor（P=0.692）,Tumor site（P=0.086）,the number of tumors（P=0.579）,and whether or not the tumor was broken during the operation（P=1.000）,tumor lobulation（P=0.065）was not related to recurrence of retroperitoneal teratoma（P>0.05）.Multivariate logistic regression analysis was performed for age and residual tumors associated with recurrence.The results showed that residual tumors（OR=13.320,95%CI=0.003-0.414,P=0.008）were significantly correlated with postoperative recurrence（P<0.05）,while the diagnostic age（P=0.052）was not a significant correlation factor for recurrence（P>0.05）.The recurrence-free survival rate of 50 patients was 75.1%,1,3,5-year recurrence-free survival rate was 96.0%,88.9%and 88.9%,respectively.Further analysis of the related factors showed that the age of the patient（P=0.007）,the location of the tumor（P=0.018）and the complete resection of the tumor（P=0.000）were the related factors affecting the recurrence-free survival rate of retroperitoneal teratoma（P>0.05）.Conclusion:Adult primary retroperitoneal teratoma is benign,rare in clinic,more in female than in male,and most common in sacrococcygeal region.Most of the patients had no obvious symptoms in the early stage,and the related compression symptoms were the main symptoms after enlargement of the tumor.Preoperative CT examination should be performed,according to fat and calcified tissue and other typical manifestations can be suggested for diagnosis.Whether or not the tumor remains during the operation is a significant factor affecting the recurrence of retroperitoneal teratoma.Complete resection of retroperitoneal teratoma is the most effective method to treat retroperitoneal teratoma.Proper surgical approach should be chosen according to the location and size of the tumor before operation,so as to completely remove the tumor and avoid recurrence.Regardless of whether the tumors are benign or malignant,the patients with retroperitoneal teratoma should be reviewed regularly after resection,especially those with residual tumors,age less than 35 years old and tumors located in sacrococcygeal region during operation,so as to detect the recurrence or malignancy of the tumors as soon as possible and treat them in time.