title: The Role of Surgery in the Management of Gestational Trophoblastic Neoplasia The Hungarian Experience.
abstract: OBJECTIVE
  To review the role of surgery in the management of gestational trophoblastic neoplasia (GTN) over the past 38 years in our national trophoblastic disease center.
  
  
  METHODS
  Between January 1, 1977, and December 31, 2014, 371 patients with low-risk GTN and 190 patients with high-risk GTN were treated with chemotherapy, surgical interventions, or both. The indications for hysterectomy included excision of large uterine tumor masses, uterine hemorrhage or sepsis, or a drug-resistant uterine focus. Metastases were excised due to the presence of drug-resistant foci or complications of disease such as hemorrhage.
  
  
  RESULTS
  Over the period of 1977-2014 74 hysterectomies, 15 resections of vaginal metastases, 3 omentectomies, 13 adnexectomies, 9 lung resections, I nephrectomy, 1 lung resection and nephrectomy, and 2 craniotomies were performed among our patients. While hysterectomy was performed in 51 (26.8%) of 190 high-risk patients, hysterectomy was performed in only 23 (6.2%) of 371 low-risk patients (p < 0.01). From 1977-2006 metastases were resected in 18.3% (26/142) and from 2007-2014 in 16.7% (8/48) of high-risk patients.
  
  
  CONCLUSIONS
  In our center surgery, particularly in the form of hysterectomy, still plays a valuable role in the management of both low- and high-risk GTN.
authors.forename: Vilmos
authors.initials: V
authors.lastname: Fülöp
authors.forename: Iván
authors.initials: I
authors.lastname: Szigetvári
authors.forename: János
authors.initials: J
authors.lastname: Szepesi
authors.forename: György
authors.initials: G
authors.lastname: Végh
authors.forename: László
authors.initials: L
authors.lastname: Zsirai
authors.forename: Ross S
authors.initials: RS
authors.lastname: Berkowitz
mesh_terms: D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003475:Curettage; D065426:Cytoreduction Surgical Procedures; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000150:complications / Q000473:pathology / Q000556:secondary / Q000628:therapy*; D006801:Humans; D006814:Hungary; D007044:Hysterectomy; D059146:Metastasectomy; D008875:Middle Aged; D009367:Neoplasm Staging; D011247:Pregnancy; D014592:Uterine Hemorrhage / Q000209:etiology / Q000601:surgery; D014594:Uterine Neoplasms / Q000150:complications / Q000473:pathology / Q000628:therapy*; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents