Obstet Gynecol Sci.  2015 Jul;58(4):277-283. 10.5468/ogs.2015.58.4.277.

Role of surgical therapy in the management of gestational trophoblastic neoplasia

• Eoh KJ
• Chung YS
• Yim GW
• Nam EJ
• Kim S
• Kim SW
• Kim YT

• KMID: 2314047
• DOI: http://doi.org/10.5468/ogs.2015.58.4.277

Abstract

OBJECTIVE
To evaluate the role of adjuvant surgical procedures in the management of gestational trophoblastic neoplasia (GTN).
METHODS
In a retrospective review of medical records at the Severance Hospital, we identified 174 patients diagnosed with GTN between 1986 and 2006. Of the 174 patients, 129 (74%) were assigned to the nonmetastatic group, and 45 (26%) to the metastatic group; of the metastatic group patients, 6 were in the low-risk group and 39 were in the high-risk group. Thirty-two patients underwent 35 surgical procedures as part of the GTN treatment. The procedures included hysterectomy, lung resection, craniotomy, uterine wedge resection, uterine suturing for bleeding, salpingo-oophorectomy, pretherapy dilatation and curettage, adrenalectomy, nephrectomy, and uterine artery embolization.
RESULTS
Of the 32 patients who underwent surgical procedures, 28 (87%) survived. Eleven patients underwent surgery for chemoresistant disease after receiving one or more chemotherapy regimens. Twelve patients underwent procedures to control tumor hemorrhage. Nine (81%) of 11 patients with chemoresistant disease survived, and 8 patients who underwent salvage surgery for chemoresistant disease received further chemotherapy. Of 21 patients who underwent hysterectomy, 19 (90%) achieved remission. All of three patients who had resistant foci of choriocarcinoma in the lung achieved remission through pulmonary resection.
CONCLUSION
Adjuvant surgical procedures, especially hysterectomy and pulmonary resection for chemoresistant disease, as well as procedures to control hemorrhage, are pivotal in the management of GTN.

Keyword

Adjuvant surgery; Gestational trophoblastic neoplasia

MeSH Terms

Adrenalectomy
Choriocarcinoma
Craniotomy
Dilatation and Curettage
Drug Therapy
Female
Gestational Trophoblastic Disease*
Hemorrhage
Humans
Hysterectomy
Lung
Medical Records
Nephrectomy
Pregnancy
Retrospective Studies
Uterine Artery Embolization

Figure

• 

  Fig. 1 A 16-week uterus filled with complete hydatidiform moles.

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