Introduction/Background Although gestational trophoblastic neoplasms (GTN) are highly chemosensitive tumors; chemoresistance was reported to occur in 15–25% of cases. As most of patients with GTN are within the reproductive age; Local myometrial resection (LMR) combined with uterine reconstruction might be considered in highly selected patients with non-metastatic GTN who wish to preserve their fertility.

Methodology A retrospective report of four cases who had been performed LMR with uterine reconstruction. The data of four cases were collected from computer and paper files of Gestational Trophoblastic clinic, Department of Obstetrics and Gynecology, Mansoura University. All cases were diagnosed initially as low-risk non metastatic GTN then developed resistance to chemotherapy. After re-assessment and counselling; they had been performed LMR as fertility-preserving surgery. The patients were followed up and serum B-hCG was checked weekly after surgery.

Results The mean age of the cases was 24.5 years. Three patients were nullipara and one case was primipara. The median operative time was 57.5 minutes and no blood transfusion was needed in all cases. The postoperative course was smooth. The post-operative histopathology revealed choriocarcinoma in two cases, invasive mole in one, and placental site trophoblastic tumor (PSTT) in one. Serum B- hCG reached a non-pregnant level after mean of 3.0 weeks of surgery. The follow up data were uneventful except ‘case 3’ who developed recurrence one month after surgery.

Conclusion Chemoresistant, non-metastatic GTN at young age can be managed with local myometrial resection with uterine reconstruction instead of hysterectomy. A multicenter-prospective study is recommended.