Objective: To evaluate the role of hysterectomy for patients with gestational trophoblastic tumor.
Methods: A total of 68 cases of gestational trophoblastic neoplasia treated by hysterectomy from 1985-1997 at PUMC hospital was retrospectively analyzed. Thirty-eight cases were diagnosed as choriocarcinoma and 30 as invasive mole.
Results: Twenty-three elder patients who didn't desire to preserve fertility were selected for hysterectomy after short courses of chemotherapy. Twenty-two of them had complete remission (95.6%). The average total course of chemotherapy was 4.2. Of twenty-seven chemo-refractory cases who were suspected of an isolated lesion in the uterus, delayed hysterectomy as an adjunct to chemotherapy was performed. Twenty of them achieved complete remission (74.1%), with an average 9.4 courses of chemotherapy. Emergency hysterectomy was indicated in 18 patients with uterine perforation or life-threatening hemorrhage. Seventeen of the emergent cases had complete remission (94.4%), who had received an average 7.6 courses of chemotherapy.
Conclusion: Although the development of effective chemotherapy has resulted in improved survival of patients with gestational trophoblastic tumor, hysterectomy remains an important adjunct treatment in a selected subset of patients. Modified radical hysterectomy is recommended for the indicated patients.