Surgical Management and Long-term Outcomes of Sacrococcygeal Teratoma in Neonates: A 30-Patient Cohort Study

Background Sacrococcygeal teratoma (SCT) is the most common congenital tumor in neonates. Complete surgical resection with coccygectomy remains the cornerstone of treatment. This study aimed to analyze surgical management strategies, mortality, and long-term outcomes in neonatal patients with SCT. Methods A retrospective cohort study was conducted on 30 neonatal patients (diagnosed within the first 28 days of life) with SCT between 2015 and 2025. Data collected included demographics, tumor characteristics, surgical details, histopathology, complications, mortality, and long-term outcomes. All patients underwent complete tumor resection with coccygectomy. Sample size calculation demonstrated adequate power for outcome analysis. Results The cohort comprised 22 females and 8 males (ratio 2.75:1). Prenatal diagnosis was achieved in 20 patients (66.7%). Median age at diagnosis was 2 days (range: 1–28 days). According to Altman classification, Type I tumors were most common (46.7%), followed by Types II (26.7%), III (20%), and IV (6.7%). Median age at surgery was 7 days. Posterior approach was used in 73.3% and combined abdominosacral approach in 26.7%. Histopathologically, mature teratoma was found in 73.3%, immature teratoma in 20%, and malignant teratoma in 6.7%. Complete resection was achieved in 93.3%. Postoperative complications occurred in 40%. Two deaths occurred (6.7% mortality): one perioperative death from high-output cardiac failure, and one late death from treatment-resistant malignant disease. At median follow-up of 48 months, four recurrences (13.3%) occurred, all successfully salvaged. Overall survival was 93.3%, and disease-free survival was 86.7%. Conclusion Neonatal SCT has excellent prognosis with appropriate surgical management. Type III tumors, large size, high-output cardiac failure, and malignant histology represent high-risk features requiring intensive management.