Objectives: To describe the characteristics of gestational trophoblastic neoplasm (GTN) patients in period of July 2015 to August 2016 at the National Hospital of Obstetrics and Gynecology and to indicate the causes of late diagnostic of the GTN patients.
Journal of military pharmaco-medicine no1-2018 CONCLUSIONS According to the research conducted on 139 patients who had colon cancer and were treated by laparoscopic colectomy at 103 Military Hospital from 01 - 2007 to 12 - 2016, we drew some conclusions: - Indicate laparoscopic colectomy for colon cancer at stage I (15.11%), stage II (25.18%) and stage III (59.71%) - Postoperative early complications: 5.76%, including 2.88% surgical wound infection; 1.44% leakage; 0.72% bleeding and 0.72% residual abscess No surgical mortality, the average postoperative circulation recovery time was 3.27 ± 1.08 days The average length of hospital stay after surgery was 10.08 ± 2.13 days - Late results were examined on 133/139 patients (95.68%) Particularly, 2.26% of them had late complication of intestinal obstruction The ratio of postoperative recurrence was 12.03% The ratio of mortality was 9.02% (12 patients) The survival rate after and years of surgery were 85.51% and 70.73%, respectively The ratio of survival and recurrence depends on cancer stage REFERENCES Le Hoang Anh Early complications and treatment for postoperative complications of laparoscopic colectomy for colon cancer Level II-specialist thesis Military Medical University Hanoi 2012 Vu Huy Hoa Results of laparoscopic colectomy for sigmoid colon cancer at Military 184 Central Hospital 108 Master Thesis in Medicine Military Medical University Hanoi 2014 To Quang Huy, Nguyen Dai Binh, Bui Dieu Five year long-term outcome after treatment of metastases on 158 cases of epithelial colon cancer Dukes B - C Hochiminh City Medical News Journal 2010, Vol 14, appendix 4, pp.263-268 Ngo Quy Lam Several clinical, subclinical characteristics and the results of surgical treatment of metastases of sigmoid colon cancer at Military Hospital 103 Master Thesis on Medicine Military Medical University Hanoi 2010 Nguyen Thanh Tam Lymph nodes in colorectal cancer PhD Thesis on Medicine Military Medical University Hanoi 2009 Nguyen Anh Tuan, Nguyen Hong Hai Laparoscopic treatment for sigmoid colon and colorectal cancer Journal of Clinical Medicine 2011, Vol 6, appendix 2, pp.102-108 Bai H.L, Chen B, Zhou Y, Wu X.T Five year long-term outcomes of laparoscopic surgery for colon cancer World Journal of Gastroenterology 2010, 16 (39), pp.4992-4997 Mastalier B, Tihon C, Simion S Surgical treatment of colon cancer Journal of Medicine and Life 2012, (3), pp.348-353 Morneau M, Boulanger J, Charlebois P, Gervais N Laparoscopic versus open surgery for the treatment of colorectal cancer Canadian Journal of Surgery 2013, 56 (5), pp.297-310 10 Xu A.G, Yu Z.J, Jiang B, Wang X.Y, Zong X.H, Liu J.H, Lou Q.Y, Gan A.H Colorectal cancer in Guangdong province of China: A demographic and anatomy survey World Journal of Gastroenterology 2010, 16 (8), pp.960-965 Journal of military pharmaco-medicine no1-2018 ASSESSMENT ON 201 PATIENTS WITH GESTATIONAL TROPHOBLASTIC NEOPLASIA AT NATIONAL HOSPITAL OF OBSTETRICS AND GYNECOLOGY IN 2015 - 2016 Nguyen Van Thang* SUMMARY Objectives: To describe the characteristics of gestational trophoblastic neoplasm (GTN) patients in period of July 2015 to August 2016 at the National Hospital of Obstetrics and Gynecology and to indicate the causes of late diagnostic of the GTN patients Subjects and methods: A cross-sectional descriptive study, 201 GTN patients were included in the research Results: The number of GTN patients after molar pregnancy: 159/201, the rest 42/201 after other pregnancies: abortion 32 cases, ectopic pregnancy cases, term delivery cases High risk GTN accounted for 34/201 cases with FIGO score from to 12 points, low risk 167/201 cases Metastasis in lung: 16 cases, in vagina: cases and in brain: cases In the group of 159 GTN patients following hydatidiform mole, up to 125/133 GTN patients in low-risk group had sufficient follow-up and 19/26 patients in high-risk group did not have Conclusion: The rate of GTN patients of high-risk group at National Hospital of Obstetrics and Gynecology remains high The insufficient follow-up after molar evacuation is the cause of late diagnosis of GTN * Keywords: Gestational trophoblastic disease; Gestatonal trophoblastic neoplasia INTRODUCTION Gestational trophoblastic disease (GTD) is an umbrella term comprises of a relatively benign condition known as complete and partial hydatidiform moles as well as malignant neoplasms such as invasive mole, choriocarcinoma, placental site trophoblastic tumor (PSTT), and epitheliod trophoblastic tumor The malignant forms of GTD are grouped together under the term of GTN Unlike other benign neoplasms, both complete and partial moles have the ability to metastasize to distant sites The malignant spectrum of this disease can progress, invade, metastasize and lead to death if left untreated GTN most commonly follows hydaltidiform mole, especially complete mole [5] However, GTN may develop after normal pregnancy, abortion or even ectopic gestation GTN and GTD, in general, are not very common in the world but in some parts of Asia including Vietnam, the rate is much higher In the Northern of Vietnam, most of GTN patients are treated in National Hospital of Obstetrics and Gynecology, among them, many cases are in late stages due to lack of surveillance after hydatidiform mole This research was carried out in order to: Describe the characteristics of GTN patients in period of July 2015 to August 2016 at National Hospital of Obstetrics and Gynecology and to indicate the causes of late diagnostic of the GTN patients * National Hospital of Obstetrics and Gynecology Corresponding author: Nguyen Van Thang (nguyenvanthang02@yahoo.com) Date received: 06/10/2017 Date accepted: 18/12/2017 185 Journal of military pharmaco-medicine no1-2018 BACKGROUND * Epidemiology: Estimates from studies conducted in North America, Australia, New Zealand, and Europe have shown the incidence of mole to range from 0.57 - 1.1 per 1,000 pregnancies, whereas studies in Southeast Asia and Japan had the incidence up to 2.0 per 1,000 pregnancies [6] The incidence rate of GTD has declined over the past decades in all populations including Asian countries, possibly related to improvement in the economy and nutrition as well as a decrease in birth rates In Hanoi, Vietnam, data from Nguyen Thin in the years 1970s noted the rate of GTD was 1/437 live births, and GTN following hydaltiform mole was 14% [1] A research on the period of 1990 - 1994 at National Hospital of Obstetrics and Gynecology has reported 570 GTN patients, 91% of them followed mole and the mortality rate up to 13.2% [2] The National Hospital of Obstetrics and Gynecology, a central hospital for obstetrics and gynecology in the North of Vietnam, admits annually hundreds of patients suffering from mole and about 200 GTD patients respectively * Pathology: GTD and GTN take their origin from the placental trophoblast, normally composed of cytotrophoblast, syncytotrophoblast and intermediate trophoblast All types of trophoblast may result in GTD when they proliferate Invasive mole, a benign tumor arises from myometrial invasion of a hydatidiform mole via direct extension 186 15% of mole results in invasive mole and 15% will metastasize to the lung or vagina Choriocarcinoma is characterized by abnormal hyperplasia and anaplasia, absence of chorionic villi, hemorrhage and necrosis, invasion into the myometrium, spreading to distant sites: lung, brain, liver, pelvis, vagina, kidney, intestines and spleen PSTT, an extremely rare form, arises from the placental implantation site * Clinical presentation depends on antecedent pregnancy, extent of disease and histopathology Irregular bleeding after evacuation of mole and enlarged uterus- ovaries are common signs Metastatic vaginal lesions may be noted Symptoms may be due to metastasis in brain (headache, seizure, hemiplegia) or in lung (dyspnea, cough and chest pain) that all need further imaging investigations: X-ray, CT (computed tomography) or MRI (magnetic resonance imaging) * βhCG monitoring: hCG is a diease-specific tumor marker, easily measured quantitatively in both urine and blood, produced by hydatidiform moles and GTN A diagnosis of postmolar GTN is made by a rising or plateauing hCG level following molar evacuation: or if there is a histological diagnosis of GTD [7] The false-positive of hCG findings (phantom) due to heterophile antibodies must be excluded Staging by FIGO 2000 [8]: Calculation of patient’s risk score by adding single factors (table 1): - points: low-risk group; ≥ points: high-risk group Journal of military pharmaco-medicine no1-2018 Table 1: FIGO risk score for GTN Risk factor Score Age (year) < 40 > 40 Antecedent pregnancy Mole Abortion Term pregnancy