The Role Of Hysterectomy In Gestational Trophoblastic Disease

Year 2017, Volume: 20 Issue: 2, 7 - 12, 08.03.2019

Pınar Çağlar Aytaç , Ülkü Mete Vural Tayfun Göngör

Abstract

Objective: To evaluate indications and role of hysterectomy in women presenting with gestational trophoblastic disease.
Material and Methods: 320 women attended to Women’s Health Research and Education Hospital Oncology Department with a
diagnosis of gestational trophoblastic disease during the period 1996-2004 were screened. Thirty patients had hysterectomy and
chemotherapy regarded as study grup (group I) and the patients followed only with chemotherapy without hysterectomy according to the treatment protocol in our hospital were regarded as control group (group II). The pretreatment risk score , remission
period after hysterectomy, the amount of given chemotherapy were evaluated from the reports retrospectively. Chi-square and
Mann-Whitney U tests were used for statistical analysis.
Results: Significant difference was observed between two groups according to the age. The median age in group I was 23.5
y(15-50), in group II was 45y(19-58)(p<0.001). According to the pretreatment risk score , given chemotherapy amount, remission
period(month) in group I respectively 4.5, 1,1. In group II respectively 3,4.5,3 (p<0.001). Hysterectomy indications were; women
who completed fertility, patient choice, heavy vaginal bleeding, chemoresistant disease, plasental site tumor pathology limited to
uterus. Post molar gestational trophoblastic disease after dilatation and curettage was 18.7%. After hysterectomy in the following
period (1-9 years), there were no invasive or metastatic disease detected.
Discussion: Chemotherapy amount that were given to get remission and remission period in the patients with low-risk potential
and who had chemoresistant disease and plasental site tumor pathology limited to the uterus were lower. Hysterectomy can be
an option in these patients with completed fertility period.

Keywords

Gestational Trophoblastic Disease, Hysterectomy

Gestasyonel Trofoblastik Hastalıklarda Histerektominin Rolü

Abstract

Amaç: Gestasyonel trofoblastik hastalık tanısı ile başvuran hastalarda histerektomi endikasyonları ve histerektominin hastalığın
takibindeki rolünü araştırmayı planladık.
Materyal Metot: Kadın Hastalıkları ve Doğum Eğitim ve Araştırma Hastanesi’ne 1996-2004 yılları arasında gestasyonel trofoblasik
hastalık tanısı ile başvuran 320 hasta retrospektif olarak tarandı. Çalışmaya takibinde kemoterapi ve histerektomi uygulanan 30
hastamız çalışma grubu olarak (grup I), yine takibinde sadece kemoterapi uygulanan 68 hastamız kontrol grubu olarak oluşturuldu ( grupII). Hastaların patolojik tanıları, yaşları , tedavi öncesi ve sonrası uygulanan tetkikler , histerektomi nedenleri, remisyon
süreleri ve aldıkları tedaviler gibi bilgiler dosyalardan taranarak incelendi. Ki-kare ve Mann Whitney U testleri istatistik analiz için
kullanıldı.
Sonuçlar: Her iki grupta yaşlar arasında istatistiksel fark saptandı. Grup I’ in ortalama yaşı 23.5 (15-50) saptanırken, grup II‘nin
ortalam yaşı 45(19-58) idi (p<0.001). Tedavi öncesi risk skorları, verilen kemoterapi kür sayısı, ve remisyon periotlarına bakıldığında
ayrı ayrı Grup I ‘de 4.5, 1, 1 bulunurken, Grup II ‘de 3,4.5, 3 olarak saptanmış ve istatistik fark saptanmıştır(p<0.001). Histerektomi
endikasyonları fertilitesini tamamlamış hastalar, hastanın isteği, yoğun vaginal kanama , kemorezistan hastalık, uterusa sınırlı plasental bölge tümörü olarak sınıflandırılmıştır. Dilatasyon ve küretaj sonrası post molar gestasyonal trofoblastik hastalık gelişme
insidansı %18.7 olarak bulunmuştur, ancak histerektomi sonrası takip sürelerinde (1-9 yıl) herhangi bir invasive mol veya metastatik hastalık görülmemiştir.
Tartışma: Histerektomi sonrası düşük riskli gestasyonel trofoblastik neoplazisi olup uterusa sınırlı plasental bölge tümorü ve ve
kemorezistan olan hastaların kemoterapi ihtiyacı ve remisyon sürelerinin daha düşük olduğu saptanmıştır. Fertilite isteği olmayan
bu grup hastalarda histerektomi önerilebilir.

Keywords

Gestasyonel trofoblastik hastalıklar, histerektomi

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