Surgical Management of Gestational Trophoblastic Disease

BackgroundGestational Trophoblastic Disease (GTD) is a rare pregnancy related condition consisting of premalignant and malignant forms arising from proliferation of trophoblastic cells. The malignant forms are collectively referred to as Gestational Trophoblastic Neoplasia (GTN) and are highly sensitive to chemotherapy. However, surgical procedures remain indispensable in the diagnosis and treatment of GTD.ObjectivesThe aim of this review is to summarize surgical interventions in the treatment of GTD and GTN. We reviewed indications, efficacy, possible complications and oncological outcomes of surgery.MethodsThree searches were performed in the databases of PubMed, Embase and the Cochrane Library to create an up-to-date overview of existing literature on the following subjects: 1. The role of primary hysterectomy in GTD and GTN 2. The role of second curettage in GTD and GTN 3. Fertility sparing surgery in GTN 4. Surgical management of metastases. Included articles originated from the time period 1952-2022. Articles written in English, Spanish and French were included.OutcomesThirty-eight articles were found and selected. Surgical evacuation through suction curettage is most used and advised in the treatment of GTD. A second curettage could be beneficial in patients with low hCG levels and low FIGO scores. In women who have completed their families, primary hysterectomy might be considered as the risk of subsequent GTN is lower than after suction curettage. In case of the rare forms of GTN (Epithelioid Trophoblastic Tumor (ETT) or Placental Site Trophoblastic Tumor (PSTT)) surgical tumor resection remains the most important step in treatment. Data on fertility sparing surgery in GTN are scarce and this treatment should be considered experimental. Conclusion and OutlookSurgery remains an important part of treatment of GTD and is sometimes indispensable to achieve curation. Further collection of evidence is needed to determine treatment steps.