Xiu Ming1,2,3, Xu Ting Ran1,2, Na Li1,4, Dan Nie5, Zheng Yu Li6,7,8. 1. Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, People's Republic of China. 2. Key Laboratory of Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, 610041, People's Republic of China. 3. Sichuan Key Laboratory of Gynecologic Oncology, West China Second University Hospital, Sichuan University, Chengdu, 610041, People's Republic of China. 4. Department of Gynecology and Obstetrics, The First People's Hospital of Zun Yi, Zunyi, 563000, People's Republic of China. 5. Department of Gynecology and Obstetrics, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People's Republic of China. 6. Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, People's Republic of China. zhengyuli@scu.edu.cn. 7. Key Laboratory of Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, 610041, People's Republic of China. zhengyuli@scu.edu.cn. 8. Sichuan Key Laboratory of Gynecologic Oncology, West China Second University Hospital, Sichuan University, Chengdu, 610041, People's Republic of China. zhengyuli@scu.edu.cn.
Abstract
PURPOSE: To determine whether or not the risk of recurrence of uterine leiomyoma (UL) was different between laparoscopic myomectomy (LM) and open myomectomy (OM). METHODS: This study combined a multicenter cohort study with a meta-analysis. The cohort study included women aged 18-44 years with 1-3 leiomyomas who underwent LM or OM for UL at one of three teaching hospitals. The meta-analysis included trials comparing recurrence rates of UL between OM and LM. RESULTS: A total of 396 patients (LM: n = 83; OM: n = 313) were recruited in the cohort study. For women aged 18-44 years with 1-3 leiomyomas, surgical approach (LM vs. OM) was not an independent risk factor of UL recurrence (31.3% vs. 34.2%, P = 0.571), and the reoperation rate of UL was similar between the LM and OM (2.4% vs. 4.2%, P = 0.726). A total of 2566 patients were meta-analyzed. The recurrence of UL was similar between LM and OM when the patients had ≤ 5 leiomyomas (OR 1.10; 95% CI 0.76-1.61; P = 0.610; I2 = 0%), while the recurrence rate in LM group was higher when the patients had > 5 leiomyomas (OR 1.50; 95% CI 1.14-1.97; P = 0.004; I2 = 38%). CONCLUSION: From the meta-analysis, the recurrence rate of UL was similar between LM and OM when the patients had ≤ 5 leiomyomas, while the recurrence of LM was higher when the number of leiomyomas was > 5. The cohort study partially supported this conclusion and it further proved the reoperation rate of UL was also similar among women aged 18-44 years with ≤ 3 leiomyomas. Therefore, OM should be considered for patients with > 3 or 5 leiomyomas if myomectomy has already been chosen.
PURPOSE: To determine whether or not the risk of recurrence of uterine leiomyoma (UL) was different between laparoscopic myomectomy (LM) and open myomectomy (OM). METHODS: This study combined a multicenter cohort study with a meta-analysis. The cohort study included women aged 18-44 years with 1-3 leiomyomas who underwent LM or OM for UL at one of three teaching hospitals. The meta-analysis included trials comparing recurrence rates of UL between OM and LM. RESULTS: A total of 396 patients (LM: n = 83; OM: n = 313) were recruited in the cohort study. For women aged 18-44 years with 1-3 leiomyomas, surgical approach (LM vs. OM) was not an independent risk factor of UL recurrence (31.3% vs. 34.2%, P = 0.571), and the reoperation rate of UL was similar between the LM and OM (2.4% vs. 4.2%, P = 0.726). A total of 2566 patients were meta-analyzed. The recurrence of UL was similar between LM and OM when the patients had ≤ 5 leiomyomas (OR 1.10; 95% CI 0.76-1.61; P = 0.610; I2 = 0%), while the recurrence rate in LM group was higher when the patients had > 5 leiomyomas (OR 1.50; 95% CI 1.14-1.97; P = 0.004; I2 = 38%). CONCLUSION: From the meta-analysis, the recurrence rate of UL was similar between LM and OM when the patients had ≤ 5 leiomyomas, while the recurrence of LM was higher when the number of leiomyomas was > 5. The cohort study partially supported this conclusion and it further proved the reoperation rate of UL was also similar among women aged 18-44 years with ≤ 3 leiomyomas. Therefore, OM should be considered for patients with > 3 or 5 leiomyomas if myomectomy has already been chosen.
Entities:
Keywords:
Laparoscopic myomectomy; Open myomectomy; Uterine leiomyoma
Authors: Anja S Frost; Meghan McMahon; Anna Jo Bodurtha Smith; Mostafa A Borahay; Kristin E Patzkowsky Journal: JSLS Date: 2021 Oct-Dec Impact factor: 2.172