The role of surgery in the treatment of trophoblastic disease.

Over 600 of the 850 cases of gestational trophoblastic disease that have been treated in our department during the last 20 years were reviewed to determine the role of surgery in the management of the disease. The surgical procedures employed included hysterectomy, both as a prophylactic and definitive procedure, thoracotomy, excision of vaginal nodules and neurosurgical removal of cerebral secondaries. It was found that removal of a large tumor mass improved the response to subsequent chemotherapy. Removal of vaginal nodules usually was not necessary unless there was hemorrhage. Chemotherapy with precise hormonal monitoring remains the most important means of treating choriocarcinoma.