Cerebral manifestations of metastatic trophoblastic disease

Surgery in the management of gestational trophoblastic disease

The role of surgery in GTD has been outlined and explained in detail. The importance of accurate diagnosis, clinical assessment, patient resuscitation and support, individualization of management and patient selection has been stressed. The prognosis for patients with GTD is now a successful outcome in 70-100% of cases, depending on the risk factors present. Cerebral lesions still present a poor prognosis especially if developed while on chemotherapy. Advances have been made in the management of choriocarcinoma since the established use of chemotherapy. Surgery plays an important adjunctive role in the improved prognosis of the disease. This has been discussed in depth. Modern surgical methods, for example selective embolization of vessels supplying vascular bleeding tumours, have improved patients' prospects. The management of hydatidiform mole has been largely resolved by the introduction of suction curettage. It is the method of choice for the evacuation of the uterus in molar disease. Controversies have been discussed and a balanced assessment has been attempted to give the reader a realistic guide to patient management when presented with these problems. Important sequelae and complications of GTD have been presented and measures of prevention and management have been advanced. It is hoped that all this will further improve the management of the patient with GTD in the future.

The role of surgery in the treatment of trophoblastic disease

Over 600 of the 850 cases of gestational trophoblastic disease that have been treated in our department during the last 20 years were reviewed to determine the role of surgery in the management of the disease. The surgical procedures employed included hysterectomy, both as a prophylactic and definitive procedure, thoracotomy, excision of vaginal nodules and neurosurgical removal of cerebral secondaries. It was found that removal of a large tumor mass improved the response to subsequent chemotherapy. Removal of vaginal nodules usually was not necessary unless there was hemorrhage. Chemotherapy with precise hormonal monitoring remains the most important means of treating choriocarcinoma.