The Role of Hysterectomy in the Treatment of Gestational Trophoblastic Neoplazias: a single center experience of 17 years

Abstract

Objective: To identify indications for hysterectomy in patients with gestational trophoblastic neoplazia (GTN) and to evaluate outcomes of hysterectomy in those patients. Design: Between December 1994 and December 2011, patients operated with the diagnosis of GTN were evaluated retrospectively. Setting: Department of Gynecologic Oncology, Aegean Obstetrics and Gynecology Education and Research Hospital, Izmir. Patients and Intervention: 17 patients with GTN undergoing total abdominal hysterectomy. Main Outcome Measures: Age at surgery, chemotherapy regimens prior to surgery, tumor stage, pre-treatment risk scores, hysterectomy indications, postoperative treatments, recurrence rates and prognosis were evaluated. Descriptive analyses were used to present findings. Results: Of the total 267 patents followed-up for gestational trophoblastic disease (GTD), 29 (10.8%) needed chemotherapy and 17 (6.3%) underwent hysterectomy. Mean age during surgery was 45.1 ± 5.4 [range: 32-58]. Sixteen (94.1%) of 17 patients received single agent or multi-agent chemotherapy prior to hysterectomy. Resistance to chemotherapy n = 8, (47%); life-threatening bleeding n = 5, (29.5%) and advanced age n = 4, (23.5%) were the hysterectomy indications. There were no mortality and major operative morbidity. Postoperatively, six (35.2%) patients were treated with 3 cures etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine (EMA-CO) regimen and one (5.8%) were treated with 2 cures methotrexate. Mean follow-up duration after hysterectomy was 91.8 ± 37.5 months [range: 6-204 months]. Overall 16/17 (94%) patients performed hysterectomy for GTN obtained complete remission. One patient with choriocarcinoma having resistance to chemotherapy prior to surgery relapsed and died of disease. Choriocarcinoma 8 (%47) was the most frequent pathology followed by invasive mole 5 (%29.5) and placental site trophoblastic tumor 4 (%23.5). Conclusion: Hysterectomy is a safe, useful and effective treatment method especially in patients having resistant disease to conventional GTD treatment and in selected cases with GTN.