Role of Surgery in the Management of Gestational Trophoblastic Neoplasia

Abstract

Gestational trophoblastic neoplasia (GTN) is now one of the most curable gynaecologic malignancies owing to effective chemotherapy and sensitive tumour marker β hCG (beta subunit of human chorionic gonadotropin). The objective of this study was to evaluate the role of adjuvant surgical procedures in the management of GTN. A retrospective review was done of available records of all GTN cases managed at our regional cancer centre from 2009 to 2017. Thirteen out of 134 patients required some surgical intervention. The number of surgical procedures done was 15. Of a total of 134 patients, 13 (9.7%) patients required surgical intervention. Thirteen patients underwent 15 surgical procedures. Two patients had more than one surgery—hysterectomy and pulmonary resection. Seven surgical procedures were done for the control of haemorrhage—one emergency hysterectomy with bilateral internal iliac ligation, one internal iliac ligation, two internal iliac embolisation, two uterine artery embolisation, and vaginal sutures in one patient. Six surgeries were done in four patients for excision of chemoresistant disease—hysterectomy in two patients and hysterectomy and pulmonary resection in two patients. Hysterectomy with BPLND was done in a case of PSTT. Small bowel resection and anastomosis were done in one patient with intestinal obstruction. Though chemotherapy is the mainstay of treatment in GTN, surgery may be necessary as a life-saving procedure in case of haemorrhage or to achieve remission in chemoresistant disease. High-risk GTN cases must be managed at tertiary care centres under care of a multidisciplinary team.