title: Role of hysterectomy in the management of patients with gestational trophoblastic neoplasia: importance of receiving treatment in reference centers.
abstract: OBJECTIVE
  To evaluate hysterectomy prevalence, indications and impact on clinical outcomes in a reference center in southern Brazil.
  
  
  METHODS
  Institutional Ethical Committee approval was granted for this study. In a cohort study spanning 21 years, all patients who underwent hysterectomy for gestational trophoblastic neoplasia (GTN) were included, and technical differences between hysterectomy performed in the reference center and those performed elsewhere were evaluated as well.
  
  
  RESULTS
  Of 1,023 patients with gestational trophoblastic disease, 57 (5.6%) underwent hysterectomy (95% CI, 4.3-7.1). Hysterectomy incidence in 230 GTN patients was 17.7% (95%CI, 15.1-23.3). Indications for 41 hysterectomies in the reference center were as follows: primary treatment in 14 (34.1%) cases and secondary treatment in 27 (65.9%); of these, the main indications were GTN recurrence (7 [25.9%] cases), hemorrhage (6 [22.2%]), resistance to single-agent chemotherapy in patients who refused more aggressive treatment (6 [22.2%]), and tumor mass reduction (5 [18.5%]). Twelve (92.3%) of the 13 hysterectomies with bilateral oophorectomy were performed elsewhere (p < 0.001). Thirty-five (85.4%) patients had no complications, and median hospitalization time was short (3 +/- 4 days). None of the 4 deaths were associated with hysterectomy. In the reference center, when associated with hysterectomy, GTN cure rates reached 93% after 63 +/- 87 months of follow-up.
  
  
  CONCLUSIONS
  When treatment is in a reference center, hysterectomy frequency and morbidity may be low, and indications due to hemorrhage are significantly lower. Furthermore, at a reference center there is significantly greater ovarian preservation at the time of hysterectomy, and significantly more patients who undergo hysterectomy have low-risk GTN.
authors: Graduate Program in Pathology, School of Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil. leticia.pires@terra.com.br
authors: Letícia Viçosa
authors: LV
authors: Pires
authors: Elza M Hartmann
authors: EM
authors: Uberti
authors: Maria do Carmo
authors: Mdo C
authors: Fajardo
authors: Adriana G Vieira
authors: AG
authors: da Cunha
authors: Marcos Wengrover
authors: MW
authors: Rosa
authors: Antonio Celso K
authors: AC
authors: Ayub
authors: Patrícia
authors: P
authors: El Beitume
mesh_terms: D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001938:Brazil; D015331:Cohort Studies; D019008:Drug Resistance, Neoplasm; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007044:Hysterectomy; D007902:Length of Stay; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010052:Ovariectomy; D011247:Pregnancy; D014594:Uterine Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*
chemical_list: D000970:Antineoplastic Agents