Remission Outcomes Following Hysterectomy in Gestational Trophoblastic Neoplasia: A Systematic Review and...

Gestational trophoblastic disease (GTD) includes premalignant and malignant entities such as choriocarcinoma and invasive mole, collectively termed gestational trophoblastic neoplasia (GTN). While chemotherapy remains the standard treatment, hysterectomy is indicated in cases of chemoresistance, significant hemorrhage, or in patients with nonmetastatic GTN who do not desire fertility preservation. This review aims to assess the effectiveness of hysterectomy in treating GTN. A systematic literature search was conducted using PubMed, EBSCOHost, ProQuest, and Google Scholar for studies published from 27 February 2000 to 27 February 2024. Exclusion criteria included single case reports, editorials, commentaries, letters, non-peer-reviewed studies, non-full-text articles, and studies without hysterectomy or relevant outcome data. Eligible studies focused on GTN and reported on remission outcomes post-hysterectomy. Three reviewers independently extracted data and analyzed it using MedCalc v19.5.1. This review is registered with PROSPERO (CRD42024556274). Seven retrospective cohort studies involving 407 patients were analyzed. The overall complete remission rate following hysterectomy was 86.6%, with higher rates in nonmetastatic cases (99.5%) and lower in metastatic cases (46.3%). Complication and mortality rates were low, with deaths occurring primarily in metastatic or high-risk patients. Hysterectomy plays a significant role in managing select GTN cases, particularly nonmetastatic or chemotherapy-resistant disease, and when fertility preservation is not desired. However, its effectiveness is limited in metastatic GTN. Postoperative monitoring of serum hCG remains crucial due to the risk of residual or metastatic disease.