IJSR - International Journal of Scientific Research

Dr Basant Kumar; Dr Vijai D Upadhyaya; Dr Ram Nawal Rao; Dr Rajanikant Yadav

Volume : VIII, Issue : VIII, August - 2019

Extra–gonadal Abdominal Germ Cell Tumor in Children: Perioperative Challenges.

Dr Basant Kumar, Dr Vijai D Upadhyaya, Dr Ram Nawal Rao, Dr Rajanikant Yadav

Abstract :

Background: Primary extra–gonadal germ cell tumors (GCTs) are rare and account for less than 4% of all GCTs. Prognosis is usually excellent after complete excision but absence of clearly defined capsules and surgical guidelines with large size of tumor made the excision difficult. Various perioperative problems reported in literature during and after excision of retroperitoneal GCTs. Here, we present our experience with non–gonadal abdominal GCTs and highlighted the perioperative problems and morbidity associated with management of these tumors. Method: From July 2012 to June 2019, all patients with primary abdominal GCTs were retrospectively reviewed. Demographic features; clinical, laboratory, radiographic, and intraoperative findings; perioperative complications; and pathology results were assessed. Result: In last seven years, 17 patients with abdominal GCTs were managed. Diagnosis were teratoma in 13 [Mature– 8; Immature– 5] and yolk sac tumor (YST) in 4 patients. 6 patients were female and age ranged from 2 months to 6 years (median 14 months). Presentations were abdominal distention and palpable lump, Fever, pain, respiratory distress, vomiting, early satiety and sub–acute bowel obstruction. Serum alfa–protein was raised in all patients. Complete excision was achieved in 15 patients. 5 patients were managed by chemotherapy with surgery while in 10 patients, only surgery was performed. Perioperative problems include excessive blood loss (2), excision of adjacent organ (2), incomplete resection (2), hypothermia (1), respiratory problems (3), chemo–related toxicity (1) and adhesive bowel obstructions (6). Re–intervention needed in 5 patients [Re–exploration for adhesive bowel obstruction–4; and radiological drainage of retroperitoneal collection–1] within 3 month of first surgery. One patient was died while 3 patients were lost in follow–up. Follow–up ranged from 6 – 60 months. Conclusion: The management of retroperitoneal/abdominal GCT is challenge. Various surgical difficulties and morbidity associated with resection of these tumors depend on its nature, size and site of tumor and on age of the patient.