Email this article FERTILITY-SPARING HYSTEROTOMY IN MALIGNANT TROPHOBLASTIC TUMOURS TREATMENT
Abstract
The aim is to improve treatment efficacy and life quality of patients with malignant trophoblastic tumours.
Fertility-sparing hysterotomy with uterine reconstruction was carried in 16 patients aged of 17 to 32 years: 2 cases due to urgent and 13 – due to planned indications.
On the basis of research, the indications for the urgent and planned fertility-sparing hysterotomy with uterine reconstruction in patients with malignant trophoblastic tumours were formulated. No postoperative complications. Steady remission in all cases. Follow up from 1 to 17 years (averaged 9.2 years).
1. Localized uterine resection with uterine reconstruction – the method of choice in malignant trophoblastic tumours surgical treatment;
2. Fertility-sparing hysterotomy with uterine reconstruction is only possible in centers which are experienced in the complex multimodality treatment of gestational trophoblastic neoplasms;
3. Basic requirement of fertility-sparing surgery is beginning adjuvant chemotherapy as soon as possible.Keywords
Full Text:
PDFReferences
Seckl, M. J., Sebire, N. J., Fisher, R. A., Golfier, F., Massuger, L., Sessa, C. (2013). Gestational trophoblastic disease: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology, 24, 39–50. doi: 10.1093/annonc/mdt345
Tse, K. Y., Ngan, H. Y. S. (2012). Gestational trophoblastic disease. Best Practice & Research Clinical Obstetrics & Gynaecology, 26 (3), 357–370. doi: 10.1016/j.bpobgyn.2011.11.009
Moodley, M., Moodley, J. (2003). Transcatheter angiographic embolization for the control of massive pelvic hemorrhage due to gestational trophoblastic disease: A case series and review of the literature. International Journal of Gynecological Cancer, 13 (1), 94–97. doi: 10.1046/j.1525-1438.2003.13016.x
Tse, K. Y., Chan, K. K., Tam, K. F. et. al. (2007). 20-year experience of managing profuse bleeding in gestational trophoblastic disease. The Journal of reproductive medicine, 52, 397–401.
Keepanasseril, A., Suri, V., Prasad, G. R. et. al. (2011). Management of massive hemorrhage in patients with gestational trophoblastic neoplasia by angiographic embolization: a safer alternative. The Journal of reproductive medicine, 56, 235–240.
Tsip, N. P., Vorobyova, L. I. (2008). Surgery in trophoblastic tumors treatment. Practical oncology, 9 (3), 179–185.
Garner, E. I. O., Meyerovitz, M., Goldstein, D. P., Berkowitz, R. S. (2003). Successful Term Pregnancy after Selective Arterial Embolization of Symptomatic Arteriovenous Malformation in the Setting of Gestational Trophoblastic Tumor. Gynecologic Oncology, 88 (1), 69–72. doi: 10.1006/gyno.2002.6861
Tsai, C.-C., Cheng, Y.-F., Changchien, C.-C., Lin, H. (2006). Successful term pregnancy after selective embolization of a large postmolar uterine arteriovenous malformation. International Journal of Gynecological Cancer, 16, 439–441. doi: 10.1111/j.1525-1438.2006.00238.x
Estrella, J. L. D., Soriano-Estrella, A. L. (2009). Conservative Management of Uterine Rupture in Gestational Trophoblastic Neoplasia. International Journal of Gynecological Cancer, 19 (9), 1666–1670. doi: 10.1111/igc.0b013e3181a84252
Kolomeyevskaya, N. V., Tanyi, J. L., Coleman, N. M., Beasley, A. D., Miller, H. J., Anderson, M. L. (2009). Balloon Tamponade of Hemorrhage After Uterine Curettage for Gestational Trophoblastic Disease. Obstetrics & Gynecology, 113 (2), 557–560. doi: 10.1097/aog.0b013e318193bff3
Doumplis, D., Al-Khatib, K., Sieunarine, K., Lindsay, I., Seckl, M., Bridges, J., Smith, J. (2007). Short communication: A review of the management by hysterectomy of 25 cases of gestational trophoblastic tumours from March 1993 to January 2006. BJOG: An International Journal of Obstetrics & Gynaecology, 114 (9), 1168–1171. doi: 10.1111/j.1471-0528.2007.01347.x
Alazzam, M., Hancock, B. W., Tidy, J. (2008). Role of hysterectomy in managing persistent gestational trophoblastic disease. The Journal of reproductive medicine, 53 (7), 519–524.
Clark, R. M., Nevadunsky, N. S., Ghosh, S., Goldstein, D. P., Berkowitz, R. S. (2010). The evolving role of hysterectomy in gestational trophoblastic neoplasia at the New England Trophoblastic Disease Center. The Journal of reproductive medicine, 55 (5-6), 194–198.
Milenkovic, V., Jeremic, K., Lazovic, B., Stefanovic, A., Mirkovic, L., Kadija, S. (2011). Fertility sparing therapy for metastatic gestational trophoblastic disease in young patients. International Journal of Gynecology & Obstetrics, 116 (2), 170–171. doi: 10.1016/j.ijgo.2011.09.020
Lin, H. W., Shieh, C. S., Chen, L. M. et. al. (2001). Spontaneous uterine perforation mimicking ectopic pregnancy as the initial presentation of placental site trophoblastic tumor. Zhonghua Yi Xue Za Zhi, 64, 545–550.
Behtash, N., Ansari, S., Sarvi, F. (2006). Successful pregnancy after localized resection of perforated uterus in choriocarcinoma and a literature review. International Journal of Gynecological Cancer, 16, 445–448. doi: 10.1111/j.1525-1438.2006.00367.x
Leiserowitz, G., Webb, M. (1996). Treatment of placental site trophoblastic tumor with hysterotomy and uterine reconstruction. Obstetrics & Gynecology, 88 (4), 696–699. doi: 10.1016/0029-7844(96)00124-x
Case, A. M., Wilson, S., Colgan, T. J., Greenblatt, E. M. (2001). Fertility-sparing surgery, with subsequent pregnancy, in persistent gestational trophoblastic neoplasia: Case report. Human Reproduction, 16 (2), 360–364. doi: 10.1093/humrep/16.2.360
Feng, F., Xiang, Y. (2010). Surgical management of chemotherapy-resistant gestational trophoblastic neoplasia. Expert Review of Anticancer Therapy, 10 (1), 71–80. doi: 10.1586/era.09.169
Kozarenko, T. M., Tsip, N. P., Medvedev, V. E. et. al. (2004). The possibilities of magnetic resonance imaging and color Doppler mapping in monitoring the efficacy of trophoblastic tumor treatment. Women's health, 2 (18), 99–103.
Feng, F., Xiang, Y., Li, L., Wan, X., Yang, X. (2009). Clinical parameters predicting therapeutic response to surgical management in patients with chemotherapy-resistant gestational trophoblastic neoplasia. Gynecologic Oncology, 113 (3), 312–315. doi: 10.1016/j.ygyno.2009.02.025
Lurain, J. R. (2011). Gestational trophoblastic disease II: classification and management of gestational trophoblastic neoplasia. American Journal of Obstetrics and Gynecology, 204 (1), 11–18. doi: 10.1016/j.ajog.2010.06.072
DOI: http://dx.doi.org/10.21303/2504-5679.2017.00341
Refbacks
- There are currently no refbacks.
Copyright (c) 2017 Nataliya Tsip
This work is licensed under a Creative Commons Attribution 4.0 International License.
ISSN 2504-5679 (Online), ISSN 2504-5660 (Print)