Clinical Investigation

The Role of Hysterectomy in the Treatment of Gestational Trophoblastic Neoplazias: a single center experience of 17 years


  • İbrahim Egemen Ertaş
  • Aşkın Doğan
  • Volkan Emirdar
  • Ahmet Güler
  • Muzaffer Sancı
  • Yusuf Yıldırım

Turk J Obstet Gynecol 2012;9(2):110-115


To identify indications for hysterectomy in patients with gestational trophoblastic neoplazia (GTN) and to evaluate outcomes of hysterectomy in those patients.


Between December 1994 and December 2011, patients operated with the diagnosis of GTN were evaluated retrospectively.


Department of Gynecologic Oncology, Aegean Obstetrics and Gynecology Education and Research Hospital, Izmir

Patients and Intervention:

17 patients with GTN undergoing total abdominal hysterectomy

Main Outcome Measures:

Age at surgery, chemotherapy regimens prior to surgery, tumor stage, pre-treatment risk scores, hysterectomy indications, postoperative treatments, recurrence rates and prognosis were evaluated. Descriptive analyses were used to present findings.


Of the total 267 patents followed-up for gestational trophoblastic disease (GTD), 29 (10.8%) needed chemotherapy and 17 (6.3%) underwent hysterectomy. Mean age during surgery was 45.1 ± 5.4 [range: 32-58]. Sixteen (94.1%) of 17 patients received single agent or multi-agent chemotherapy prior to hysterectomy. Resistance to chemotherapy n = 8, (47%); life-threatening bleeding n = 5, (29.5%) and advanced age n = 4, (23.5%) were the hysterectomy indications. There were no mortality and major operative morbidity. Postoperatively, six (35.2%) patients were treated with 3 cures etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine (EMA-CO) regimen and one (5.8%) were treated with 3 cures methotrexate. Mean follow-up duration after hysterectomy was 91.8 ± 37.5 months [range: 6-204 months]. Overall 16/17 (94%) patients performed hysterectomy for GTN obtained complete remission. One patient with choriocarcinoma having resistance to chemotherapy prior to surgery relapsed and died of disease. Choriocarcinoma 8 (%47) was the most frequent pathology followed by invasive mole 5 (%29.5) and placental site trophoblastic tumor 4 (%23.5).


Hysterectomy is a safe, useful and effective treatment method especially in patients having resistant disease to conventional GTD treatment and in selected cases with GTN.

Keywords: Gestational Trophoblastic Neoplasms, Hysterectomy