Integration of surgery and other techniques in the management of trophoblastic malignancy.

The role of surgery in the management of gestational trophoblastic neoplasms has changed over the years and warrants continuous re-evaluation. Surgical removal of the bulk of the disease in an attempt to shorten the hospital course and decrease the amount of chemotherapy required appears to be of value. This approach to therapy should therefore be considered in most patients with nonmetastatic disease without regard to the histologic diagnosis if they have completed their families. "Debulking" of primary uterine disease in the presence of metastases may decrease the chemotherapy necessary for cure and removes a potential source of resistant disease. Pulmonary surgery improves survival rates for patients with a solitary, resistant lung tumor and is advisable under the circumstances outlined herein. Craniotomy is rarely of value in the management of tumor in the brain but may be necessary in emergency situations caused by intracerebral hemorrhage. Surgery to control complications of the disease has been proved to be safe with acceptable morbidity even if performed during chemotherapy. Thus, although chemotherapy has replaced surgery as the primary management of patients with gestational trophoblastic disease, there remain a significant number of patients in whom surgery plays a significant role.