The Role of Surgery in the Management of Gestational Trophoblastic Neoplasia

Although sensitive human chorionic gonadotropin assays and advances in chemotherapy have assumed primary importance in the management of gestational trophoblastic neoplasia, surgery remains important in the overall care of these patients. Management of molar pregnancies consists of surgical evacuation and subsequent monitoring. Hysterectomy decreases the risk of post–molar trophoblastic disease in appropriate patients and, when incorporated to primary management of gestational trophoblastic neoplasia, can decrease the chemotherapy requirements of patients with low-risk disease. In patients with high-risk disease, surgical intervention is frequently required to control complications of disease or as therapy to stabilize patients during chemotherapy. Hysterectomy, thoracotomy, or other extirpative procedures may be integrated into the management of patients with chemorefractory disease. Interventional procedures are useful adjuncts to control bleeding from metastases. Target Audience: Obstetricians and gynecologists, family physicians Learning Objectives: After completing this CME activity, physicians should be better able to manage treatment of the hydatidiform mole, identify the indications for use of hysterectomy in the primary and delayed setting with molar pregnancy and malignant gestational trophoblastic neoplasia, discuss the controversial subject of repeat curettage for gestational trophoblastic disease, and choose the appropriate method of surgical extirpation in the setting of isolated metastases and chemoresistant high-risk disease.