Role of surgical therapy in the management of gestational trophoblastic neoplasia.
10.5468/ogs.2015.58.4.277
- Author:
Kyung Jin EOH
1
;
Young Shin CHUNG
;
Ga Won YIM
;
Eun Ji NAM
;
Sunghoon KIM
;
Sang Wun KIM
;
Young Tae KIM
Author Information
1. Women's Cancer Clinic, Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea. ytkchoi@yuhs.ac
- Publication Type:Original Article
- Keywords:
Adjuvant surgery;
Gestational trophoblastic neoplasia
- MeSH:
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
- From:Obstetrics & Gynecology Science
2015;58(4):277-283
- CountryRepublic of Korea
- Language:English
-
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.
