Role of Surgery in the Management of Hydatidiform Mole in Elderly Patients

Giorgione, Veronica; Bergamini, Alice; Cioffi, Raffaella; Pella, Francesca; Rabaiotti, Emanuela; Petrone, Micaela; Candiani, Massimo; Mangili, Giorgia

doi:10.1097/igc.0000000000000903

Cited by 12 publications

(19 citation statements)

References 10 publications

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“…In comparison, our study consisted of 37 patients in the prophylactic hysterectomy group, which theoretically should lead to more reliable results. It is worth mentioning that a recent study [ 17 ] showed that hysterectomy after 40 years old in women with HM does not reduce the incidence of GTN. In this study, a total of 76 patients with HM who were over 40 years old were included.…”

Section: Discussionmentioning

confidence: 99%

“…The prophylactic effect of total hysterectomy is similarly controversial. While some studies demonstrated that it could potentially prevent the malignancy of CHM [ 15 , 16 , 14 ], others argued it could not reduce the incidence of GTN [ 17 , 18 ]. Moreover, few of the above-mentioned studies specifically targeted patients who are at least 40 years old.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of different therapeutic strategies for complete hydatidiform mole in women at least 40 years old: a retrospective cohort study

2017

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BackgroundThere are three main therapeutic strategies, namely expectant management (dilation and curettage only), prophylactic chemotherapy and prophylactic total hysterectomy for treating older women with complete hydatidiform mole (CHM). However, the scientific community has so far, not unanimously accepted the above-mentioned methods. The objective of this study was to evaluate the effectiveness of these therapeutic strategies in preventing post-molar gestational trophoblastic neoplasia (GTN) pertaining to patients with CHM who were at least 40 years old.MethodsHundred and seventy-one patients from our hospital who had histologically been diagnosed of CHM and underwent treatment from January 2004 to December 2013 were included. All patients were followed continuously for a minimum of 2 years after which relevant clinical data were extracted and analysed.ResultsAll patients were divided to three groups. Group 1 consisted of 124 patients, treated by expectant management, and the incidence of post-molar GTN was 37.1%. Group 2 included 12 patients who received prophylactic chemotherapy, with an incidence of 41.7%. The remaining 35 patients, Group 3, underwent prophylactic total hysterectomy, with the lowest incidence of 11.4%. A significantly lower incidence was noted in group 3 as compared to group 1 (P = 0.004). GTN patients who received prophylactic chemotherapy required, on average, longer time to be diagnosed of GTN and had higher probability of chemotherapy resistance (P = 0.031 and P = 0.024).ConclusionsThis retrospective analysis showed that prophylactic total hysterectomy was the most effective therapeutic strategy for treating CHM in women at least 40 years old of age.Electronic supplementary materialThe online version of this article (10.1186/s12885-017-3749-8) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of different therapeutic strategies for complete hydatidiform mole in women at least 40 years old: a retrospective cohort study

2017

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“…Although variables such as maternal age over 40 years and a longer interval to achieve an undetectable β-hCG level are associated with an increased risk of GTN, the benefits of prophylactic chemotherapy and hysterectomy are controversial. [ 16 , 17 ] In contrast to Knol's point of view, [ 8 ] we believe that hysterectomy is not a necessary treatment for patients over 40 years of age (patients 5, 10, 15, and 16), as it showed no obvious benefits in patients with pulmonary deportation. The results of our study favored reducing the use of unnecessary toxic therapies or invasive manipulation after balancing the future risk of GTN with patient safety.…”

Section: Discussionmentioning

confidence: 86%

Pulmonary deportation of hydatidiform mole: a 12-year, single tertiary center experience in China

Dai

Xiang

Feng

et al. 2020

Chinese Medical Journal

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Background Pulmonary deportation of hydatidiform mole is an exceedingly rare entity. The underlying mechanisms and proper management strategies remain unclear based on sporadic case reports over the past six decades. This study aimed to investigate the clinical features and rational treatment of patients with benign molar pregnancies with pulmonary deportation based on our experience. Methods Medical records of 20 cases of hydatidiform mole with pulmonary deportation were retrospectively reviewed at Peking Union Medical College Hospital from November 2006 to May 2019. The detailed information of all patients was recorded and analyzed. Patients were divided into different groups according to their characteristics and Mann-Whitney U test was used to compare the duration to achieve a normal β-human chorionic gonadotrophin (β-hCG) level after the first evacuation among groups. Results Initial pulmonary computed tomography scans showed suspected bilateral, left and right chest deportation of hydatidiform mole in 12, four, and four patients, respectively, with the maximum nodular diameter ranging from 0.6 to 1.2 cm. Ten patients achieved lesion resolution while the remaining ten patients achieved decreases in the size of their pulmonary lesions. The median duration to achieve a normal β-hCG level after the first evacuation was 15.5 (13.0, 21.9) weeks. There was no significant difference in the duration to achieve a normal β-hCG level after the first evacuation between two groups based on age (≥40 years vs . < 40 years: 15.8 [12.2, 21.5] weeks vs . 15.5 [12.9, 23.0] weeks, Z = 0.094, P = 0.925), type of antecedent mole (partial mole vs . complete mole: 15.2 [12.5, 27.4] weeks vs . 15.9 [12.9, 21.5] weeks, Z = 0.165, P = 0.869), distribution of pulmonary nodules (bilateral lungs vs . unilateral lung: 15.2 [12.8, 22.5] weeks vs . 15.9 [13.2, 22.2] weeks, Z = 0.386, P = 0.700), maximum size of pulmonary nodules (>0.5 cm vs . ≤0.5 cm: 13.0 [11.3, 17.2] weeks vs . 16.0 [14.5, 23.8] weeks, Z = 1.815, P = 0.070), and number of uterine evacuations (once vs . twice or three times: 15.0 [13.0, 16.3] weeks vs . 16.0 [12.8, 23.9] weeks, Z = 0.832, P = 0.405). The post-molar cohort was followed up for 17 to 139 months, and no gestational trophoblastic neoplasia was observed. Conclusions No surgeries other than uterine evacuation and no chemotherapy regim...

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“…Similarly, Zhao et al found that the incidence of post-molar GTN in women aged >40 years was significantly lower in patients who had hysterectomy compared to patients who had dilatation and curettage (11% vs 37%, P =0.004) for complete mole [ 24 ]. In contrast, Giorgione et al reported that in women with hydatidiform mole aged >40 years, primary hysterectomy does not reduce the incidence of port-molar GTN when compared with dilatation and curettage (58% vs 30% respectively, P =0.094) [ 25 ]. Moreover, they also found that hysterectomy does not reduce the amount of chemotherapy required to treat GTN, although 42% (5 out of 12) of their patients who had primary hysterectomy achieved complete remission after surgery.…”

Section: Surgery For Hydatidiform Molementioning

confidence: 99%

Surgery including fertility-sparing treatment of GTD

Ngu

Ngan

2021

Best Practice & Research Clinical Obstetrics & Gynaecol

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Gestational trophoblastic disease (GTD) consist of a spectrum of diseases, including hydatidiform moles, invasive mole, metastatic mole, choriocarcinoma, placental site trophoblastic tumour (PSTT) and epithelioid trophoblastic tumour (ETT). GTD are relatively uncommon disease occurring in women of reproductive age, with high cure rates. Primary treatment of hydatidiform moles includes uterine evacuation, followed by close monitoring of serial hCG levels to detect for post-molar gestational trophoblastic neoplasia (GTN). In patients with GTN, the main therapy consists of chemotherapy, although some surgical procedures are important in selected patients in order to achieve cure. Hysterectomy is the mainstay treatment for PSTT or ETT, and may be considered in selected patients for management of hydatidiform mole and malignant GTN especially in chemoresistant disease. Resection of metastatic lesions such as in the lung or brain can be considered in selected patients with isolated chemoresistant tumour. Surgical treatment of GTD will be discussed in this chapter.

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Role of Surgery in the Management of Hydatidiform Mole in Elderly Patients

Abstract: Primary hysterectomy after 40 years old in women affected by HM does not reduce the incidence of GTN and amount of chemotherapy. Although further studies are needed to confirm these results, a careful hCG monitoring should be recommended in these high-risk patients.

Cited by 12 publications

References 10 publications

Comparison of different therapeutic strategies for complete hydatidiform mole in women at least 40 years old: a retrospective cohort study

Comparison of different therapeutic strategies for complete hydatidiform mole in women at least 40 years old: a retrospective cohort study

Pulmonary deportation of hydatidiform mole: a 12-year, single tertiary center experience in China

Surgery including fertility-sparing treatment of GTD

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