We analyzed the role of surgery in the treatment for trophoblastic tumors in 70 patients managed at the Gynecology Department of N.N. Blokhin CRC, RAMS, during 1996-2003. Before admission to the CRC 11 patients underwent various surgical procedures, with 4 of them also receiving chemotherapy to follow. At the CRC all the cases started treatment with chemotherapy. All 38 patients having tumors at low to mediate risk of chemoresistance were cured by chemotherapy alone. Ten of 32 high-risk patients underwent surgery. Five operations were performed in 4 cases for refractory primary or metastatic tumors (hysterectomy, removal of a bladder wall metastasis, thoracoscopic pulmonary lobectomy). On completion of line I-II chemotherapy the remaining 6 patients had preservation hysterotomy (2), hysterectomy (3) or dissection of a residual metastasis in the vaginal wall (1). Ten of 11 patients undergoing surgery before chemotherapy presented with distant metastases at admission to the CRC, 3 of them died from disease progression. Of the 4 cases receiving surgery for refractory tumors 2 have been cured and one patient continues treatment. All the 6 patients having surgery after chemotherapy completion are cured. Up-to-date treatment for trophoblastic disease including standard chemotherapy regimens reduces the need in surgery to 16% (vs 43% in previous years) with hysterectomy accounting for only 4.3% (vs up to 40% previously) and prevents bleeding requiring surgery. Surgery is indicated in cases with refractory primary or solitary metastases to improve treatment outcomes.
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