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Reintervention risk and quality of life outcomes after uterine-sparing interventions for fibroids: a systematic review and meta-analysis. | LitMetric

Reintervention risk and quality of life outcomes after uterine-sparing interventions for fibroids: a systematic review and meta-analysis.

Fertil Steril

Department of Gynecology, Leiden University Medical Center, Leiden, the Netherlands; Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands.

Published: April 2018

AI Article Synopsis

  • - The study aims to compare different uterine-sparing treatments for fibroids based on the risk of needing further procedures and their effects on quality of life, using systematic review and meta-analysis methods.
  • - Analysis included 85 articles with nearly 17,800 women, revealing varied reintervention risks after 60 months: 12.2% for myomectomy, 14.4% for UAE, 53.9% for HIFU, and 7% for hysteroscopy, with all treatments showing improved quality of life.
  • - The findings highlight the importance of understanding the effectiveness of these treatments, noting a need for more long-term data especially for newer methods, to aid patient counseling.

Article Abstract

Objectives: To compare uterine-sparing treatment options for fibroids in terms of reintervention risk and quality of life.

Design: Systematic review and meta-analysis according to PRISMA guidelines.

Setting: Not applicable.

Patient(s): Women with uterine fibroids undergoing a uterine-sparing intervention.

Interventions(s): Not applicable.

Main Outcome Measure(s): 1) Reintervention risk after uterine-sparing treatment for fibroids after 12, 36, and 60 months; and 2) quality of life outcomes, based on validated questionnaires. Two separate analyses were performed for the procedures that used an abdominal approach (myomectomy, uterine artery embolization [UAE], artery ligation, high-intensity focused ultrasound [HIFU], laparoscopic radiofrequency ablation [RFA]) and for the procedures managing intracavitary fibroids (hysteroscopic approach, including hysteroscopic myomectomy and hysteroscopic RFA).

Result(s): There were 85 articles included for analysis, representing 17,789 women. Stratified by treatment options, reintervention risk after 60 months was 12.2% (95% confidence interval [CI] 5.2%-21.2%) for myomectomy, 14.4% (95% CI 9.8%-19.6%) for UAE, 53.9% (95% CI 47.2%-60.4%) for HIFU, and 7% (95% CI 4.8%-9.5%) for hysteroscopy. For the other treatment options, no studies were available at 60 months. For quality of life outcomes, symptoms improved after treatment for all options. The HIFU procedure had the least favorable outcomes.

Conclusion(s): Despite the substantial heterogeneity of the study population, this meta-analysis provides valuable information on relative treatment efficacy of various uterine-sparing interventions for fibroids, which is relevant when counseling patients in daily practice. Furthermore, this study demonstrates that long-term data, particularly for the newest uterine-sparing interventions, are urgently needed.

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Source
http://dx.doi.org/10.1016/j.fertnstert.2017.11.033DOI Listing

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