Surgical intervention during chemotherapy of gestational trophoblastic neoplasms

The role of surgical intervention during chemotherapy of women with gestational trophoblastic neoplasms has been analyzed in a series of 194 women treated with chemotherapy during the past 10 years. Of the 138 women with metastatic disease 27 (19.6%) required some type of major surgical procedure following the onset of chemotherapy whereas surgery was indicated in only 3 (5.4%) of the 56 women whose disease was limited to the uterus. The most common indications for surgery in patients with metastatic disease were control of hemorrhage, removal of the only apparent site of disease following partial response to chemotherapy, relief of urinary tract obstruction and treatment of infection. Surgical control of complications allowed some of these patients to survive so that they ultimately could be cured by chemotherapy. There was no evidence that surgery carried out during or just prior to a period of drug‐induced leukopenia or thrombocytopenia was associated with any impairment of wound healing or increased incidence of postoperative complications.