Role of surgery in the management of high-risk gestational trophoblastic neoplasia

John Robert Lurain III*, Diljeet K. Singh, Julian C. Schink

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

77 Scopus citations

Abstract

OBJECTIVE: To evaluate the role of surgery in the management of high-risk gestational trophoblastic neoplasm. STUDY DESIGN: Twenty-four (48%) of 50 patients treated with etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine (EMA-CO) regimen as primary or secondary chemotherapy for high-risk gestational trophoblastic neoplasia between 1986 and 2005 underwent 28 adjuvant surgical procedures. The procedures included hysterectomy (17), lung resection (5), salpingectomy (1), uterine wedge resection (1), small bowel resection (1), suturing of the liver or uterus for bleeding (2) and uterine artery embolization (1). RESULTS: Twenty-one (87.5%) of 24 patients who had surgical procedures as part of their treatment for high-risk disease survived. Fifteen (88%) of 17 patients undergoing hysterectomy were cured. Four (80%) of 5 patients who had resistant foci of choriocarcinoma in the lung were cured by pulmonary resection. The patients who had suturing of the uterus, uterine artery embolization, small bowel resection and salpingectomy for bleeding as well as the patient who had uterine wedge resection of resistant choriocarcinoma survived. CONCLUSION: Adjuvant surgical procedures, especially hysterectomy and pulmonary resection for chemotherapy-resistant disease as well as procedures to control hemorrhage, are important components in the management of high-risk gestational troplioblastic neoplasia. Twenty-four (48%) of 50 patients with high-risk gestational troplioblastic neoplasia in this series underwent surgical procedures, and 21 (87.5%) were cured.

Original languageEnglish (US)
Pages (from-to)773-776
Number of pages4
JournalJournal of Reproductive Medicine for the Obstetrician and Gynecologist
Volume51
Issue number10
StatePublished - Oct 1 2006

Keywords

  • EMA-CO protocol
  • Gestational trophoblastic neoplasms
  • Surgery

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynecology

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