Outcomes of minimally invasive versus open abdominal hysterectomy in patients with gestational trophoblastic disease

Diagnosis and management of gestational trophoblastic disease: 2021 update

“…Minimally invasive versus open abdominal hysterectomy in patients with GTD appears to have comparable oncologic outcomes with less blood loss and shorter hospital stay. 5 Laparotomy may be needed to stop bleeding in organs such as the liver, gastrointestinal tract, kidneys, and spleen. Neurosurgery is needed if there is bleeding into the brain or increased intracranial pressure.…”

Epidemiology, diagnosis, and treatment of gestational trophoblastic disease: A Society of Gynecologic Oncology evidenced-based review and recommendation

“…In women older than 50 years, the risk of post-evacuation GTN may be as high as 60%, regardless of presenting hCG level [39], though population based studies place this risk for older women around 30% [10]. For these women, or for those in whom reliable hCG follow up cannot be obtained, hysterectomy should be considered [39][40][41]. Although use of prophylactic chemotherapy at the time of hysterectomy for molar pregnancy has been shown to decrease the risk of developing GTN, for those that do develop GTN despite prophylactic chemotherapy, there is often a delayed diagnosis, increase drug resistance, exposure to toxicity, and worse outcome [42,43].…”

“…If there is an inadequate response to the initial single agent,if there are new metastases, and/or if hCG plateaus at a high level (>3000 IU/L), then multi-agent chemotherapy regimens should be employed [2]. Additionally, for those with resistant disease, hysterectomy or resection of persistent metastatic disease could be considered, especially for those who no longer desire to preserve their fertility [41,73].…”

“…Hysterectomy as well as resection of oligometastatic extra-uterine disease plays an important role in the management of those with isolated chemoresistant disease or those with uterine confined disease who no longer desire to preserve fertility [91,92]. Furthermore, salvage hysterectomy, rather than use of multi-agent chemotherapy, should be considered in patients with evidence of persistent uterine disease despite single agent chemotherapy [41,73]. Surgery may also be necessary to deal with disease-related hemorrhage complications when embolization is not available or has failed.…”

Gestational Choriocarcinoma

“…Gabilondo [23] comment that in an analysis carried out in 2016 it was determined that actinomycin D leads to higher cure rates than methotrexate as monotherapy, however, in the case of high-risk disease, chemotherapy is based on the administration of multiple pharmacological agents, among which the EMA-CO regimen stands out, recognized as the first line of treatment due to high survival rates as well as low toxicity when using high doses. of methotrexate, folic acid, actinomycin D, cyclophosphamide and vincristine [24][25][26][27]. The duration of drug administration will also depend on the type and stage of the disease since, in cases of low-risk disease, remission is defined as the moment in which undetectable beta-hCG levels are obtained for at least 3 weeks while, in high-risk cases.…”