title: Role of surgery in the management of high-risk gestational trophoblastic neoplasia.
abstract: OBJECTIVE
  To evaluate the role of surgery in the management of high-risk gestational trophoblastic neoplasia.
  
  
  METHODS
  Twenty-four (48%) of 50 patients treated with etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine (EMA-CO) regimen as primary or secondary chemotherapy for high-risk gestational trophoblastic neoplasia between 1986 and 2005 underwent 28 adjuvant surgical procedures. The procedures included hysterectomy (17), lung resection (5), salpingectomy (1), uterine wedge resection (1), small bowel resection (1), suturing of the liver or uterus for bleeding (2) and uterine artery embolization (1).
  
  
  RESULTS
  Twenty-one (87.5%) of 24 patients who had surgical procedures as part of their treatment for high-risk disease survived. Fifteen (88%) of 17 patients undergoing hysterectomy were cured. Four (80%) of 5 patients who had resistant foci of choriocarcinoma in the lung were cured by pulmonary resection. The patients who had suturing of the uterus, uterine artery embolization, small bowel resection and salpingectomy for bleeding as well as the patient who had uterine wedge resection of resistant choriocarcinoma survived.
  
  
  CONCLUSIONS
  Adjuvant surgical procedures, especially hysterectomy and pulmonary resection for chemotherapy-resistant disease as well as procedures to control hemorrhage, are important components in the management of high-risk gestational trophoblastic neoplasia. Twenty-four (48%) of 50 patients with high-risk gestational trophoblastic neoplasia in this series underwent surgical procedures, and 21 (87.5%) were cured.
authors.affiliation: John I. Brewer Trophoblastic Disease Center, Northwestern University Feinberg School of Medicine, Prentice Women's Hospital, Chicago, Illinois 60611, USA. jlurain@nmff.org
authors.forename: John R
authors.initials: JR
authors.lastname: Lurain
authors.forename: Diljeet K
authors.initials: DK
authors.lastname: Singh
authors.forename: Julian C
authors.initials: JC
authors.lastname: Schink
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D003609:Dactinomycin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007044:Hysterectomy; D007087:Illinois; D008499:Medical Records; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D011247:Pregnancy; D012189:Retrospective Studies; D016019:Survival Analysis; D014594:Uterine Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D003609:Dactinomycin; D014750:Vincristine; D005047:Etoposide; D003520:Cyclophosphamide; D008727:Methotrexate