April 9th, 2020

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Outcomes of Suction Curettage Versus Hysterectomy for the Treatment of Hydatidiform Mole Among Women Aged 40 Years or Older
Authors:  Ruangsak Lertkhachonsuk, M.D., Arb-aroon Lertkhachonsuk, M.D., and Vorapong Phupong, M.D.
  OBJECTIVE: To investigate the risk of postmolar gestational trophoblastic neoplasia (GTN) in hydatidiform mole patients aged ≥40 years treated by suction curettage versus hysterectomy.

STUDY DESIGN: All cases of hydatidiform mole among women aged ≥ 40 years treated at 2 university hospitals in Bangkok, Thailand, between 2000–2015 were reviewed. Clinical data, case management, and outcomes of treatment were analyzed.

RESULTS: Thirty-eight cases of hydatidiform mole patients met criteria. Twenty cases were treated by primary suction curettage, and 18 cases underwent primary hysterectomy. There were no significant differences in patient characteristics between groups. Average uterine size was significantly larger in the hysterectomy group (14.9 vs. 12.6 weeks, p=0.02). Postmolar GTN developed in 13 of 38 cases (34.21%), with 8 of 20 (40%) in the suction curettage group and 5 of 18 (27.8%) in the hysterectomy group (p=0.43). Five cases received hysterectomy as secondary surgery. From 23 hysterectomy specimens, invasive mole was identified in 10 cases (43.5%) and choriocarcinoma in 1 case.

CONCLUSION: Risk of postmolar GTN was not significantly different when comparing suction curettage and hysterectomy as primary treatment. Almost half of hysterectomy specimens revealed invasive mole, which may explain why there is an increase of GTN in older patients.
Keywords:  adult, clinical protocols, female, gestational trophoblastic disease, hydatidiform mole, hysterectomy, invasive mole, pregnancy, treatment outcome, trophoblastic neoplasms
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