The role of operation in the current therapy of gestational trophoblastic disease.

Results of therapy of 257 patients with gestational trophoblastic disease (GTN), treated at one institution and by the same group of physicians (1966 to 1978), are presented. An overall remission rate of 92% was achieved: nonmetastatic disease, 139/139 (100%); "good" prognosis metastatic GTN, 55/55 (100%), "poor" metastatic GTN, 42/63 (66%). Chemotherapy, single- or multi-agent, was the primary treatment modality but selected patients were also treated with operation and/or x-ray therapy. Surgical therapy (hysterectomy), performed coincident with the institution of systemic chemotherapy, was shown to significantly reduce the duration of hospitalization and the amount of chemotherapy used to achieve remission, regardless of whether or not metastases were present. Delayed surgical excision of chemotherapy-resistant foci of GTN was of benefit, though less effective than initial operation. Surgical intervention for other diseases or for complications of GTN or its treatment was quite useful to stabilize patients and allow successful chemotherapy to be completed. There were no problems attributable to chemotherapy when wound healing or other postoperative complications were considered.