The value of hysterectomy in the management of gestational trophoblastic neoplasia: a retrospective analysis

While chemotherapy is central to gestational trophoblastic disease (GTD) management, concerns over toxicity and resistance have renewed interest in hysterectomy. This study evaluated outcomes of patients treated with hysterectomy, focusing on histopathology, chemotherapy use, and survival. A retrospective analysis was performed on consecutive eligible patients undergoing hysterectomy for GTD from 2014 to 2023. Data on demographics, surgery indications, chemotherapy, and follow-up were collected and analyzed. Among 96 GTD patients undergoing hysterectomy, the timing of surgery was a key determinant of treatment intensity. Patients who underwent first-line hysterectomy (n = 34) required significantly fewer chemotherapy cycles to achieve remission than those needing surgery after failed chemotherapy (non-first-line hysterectomy) (median: 2 [IQR: 1–4] vs. 7 [IQR: 5–9] cycles; P <0.001). This benefit was most evident in low-risk patients (WHO score 0–6), where primary surgery alone achieved cure in selected cases, thereby reducing or eliminating chemotherapy exposure. Hysterectomy was also definitive for chemoresistant histologies (placental site trophoblastic tumor and epithelioid trophoblastic tumor). The overall survival rate was 95% for the gestational trophoblastic neoplasia cohort. This study demonstrates that first-line hysterectomy significantly reduces postoperative chemotherapy requirements for patients with GTD, particularly in the low-risk subgroup. These findings support integrating timely surgical intervention into risk-adapted treatment algorithms to de-escalate systemic therapy while maintaining high survival rates. For patients with chemoresistant histologies, hysterectomy remains a definitive therapeutic option.