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KMID : 0358420150580040277
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Korean Journal of Obstetrics and Gynecology
2015 Volume.58 No. 4 p.277 ~ p.283
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Role of surgical therapy in the management of gestational trophoblastic neoplasia
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Eoh Kyung-Jin
Chung Young-Shin
Yim Ga-Won
Nam Eun-Ji
Kim Sung-Hoon
Kim Sang-Wun
Kim Young-Tae
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Abstract
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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.
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KEYWORD
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Adjuvant surgery , Gestational trophoblastic neoplasia
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