Surgical management of chemotherapy-resistant gestational trophoblastic neoplasia

Gestational trophoblastic neoplasia (GTN) are a broad spectrum of placental lesions. Chemotherapy is the primary treatment for GTN and the vast majority of women with GTN are cured with their initial chemotherapy treatment. However, some patients become chemotherapy-resistant and fail to achieve a complete remission following initial chemotherapy and need salvage chemotherapy. A small minority of patients are still unresponsive to salvage multidrug chemotherapy. Currently, adjuvant surgical procedures could be excellent adjuncts to salvage chemotherapy in removing known foci of chemotherapy-resistant disease in selected patients with persistent GTN. This article will review the surgical management of chemotherapy-resistant GTN, focusing on the relevant indication of surgery, factors affecting efficacy and the use of surgical procedures in selected patients.