The role of hysterectomy in the therapy of gestational trophoblastic tumor.

OBJECTIVE

To evaluate the role of hysterectomy for patients with gestational trophoblastic tumor.

METHODS

We retrospectively analyzed 68 cases of gestational trophoblastic neoplasia treated by hysterectomy from 1985 to approximately 1997 at PUMC hospital. Thirty-eight cases were diagnosed of choriocarcinoma and 30 were invasive mole.

RESULTS

Twenty-three elder patients who didn't desire to preserve fertility were selected for hysterectomy after shorter courses of chemotherapy, 22 of them had a complete remission (95.6%), the total average courses of chemotherapy was 4.2. Of twenty-seven chemorefractory cases who were suspected of a refractory isolated lesion in the uterus, delayed hysterectomy as an adjunct to chemotherapy was performed, 20 of them got a complete remission (71.1%), the total average courses of chemotherapy were 9.4. Emergency hysterectomy is indicated in 18 patients with uterine perforation or life-threatening hemorrhage, 17 cases had a complete remission (94.4%), the total average courses of chemotherapy were 7.6.

CONCLUSION

Although the development of effective chemotherapy has resulted in improved survival of patients with gestational trophoblastic tumor, hysterectomy remains an important adjuncts in the treatment of a selected subset of patients; in order to operate more completely and prevent recurrence, it's better to perform extended hysterectomy for the indicated patients.