Role of hysterectomy in managing persistent gestational trophoblastic disease.

Objective: To evaluate incidence, indications and outcomes of hysterectomy for gestational trophoblastic disease (GTD) and compare outcomes for patients who underwent primary hysterectomy with outcomes for those who underwent adjuvant hysterectomy.

Study Design: Using the Sheffield Trophoblastic Tumour Centre database (January 1, 1986, until June 30, 2007), patients who underwent hysterectomy were identified, along with age, antecedent pregnancy, diagnosis date, hysterectomy date and chemotherapy and pathologic findings.

Results: A total of 8,860 patients were registered at Weston Park Hospital, Sheffield. Of them, 627 (7.1%) needed chemotherapy and 62 (0.71%) underwent hysterectomy. The most frequent indication was resistance to chemotherapy in 22 of 62 (35.5%), followed by major hemorrhage in 21 of 62 (33.9%). Emergent hysterectomy was performed in 22 (35.5%). Mean International Federation of Gynecology and Obstetrics risk score was 6.5. Choriocarcinoma was the most frequent pathology (23), followed by invasive mole (10) and placental site trophoblastic tumor (9). Thirty-one patients needed chemotherapy after hysterectomy, 93.5% are in remission, 7 relapsed, 3 were cured and 4 died of disease.

Conclusion: Incidence of hysterectomy for GTD was 1 in 140. Patients who underwent hysterectomy represent a high-risk group, often having more aggressive pathology. Hysterectomy is valuable as primary and adjuvant treatments.