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Long term follow up of hysteroscopic myomectomy assessed by survival analysis
1Endoscopy Training Centre, University Department of Obstetrics and Gynaecology, The Royal Free Hospital, London, UK.
Objective:
To identify patient characteristics which affect outcome after hysteroscopic myomectomy for submucous fibroids.
Design:
Prospective observational study.
Setting:
A university teaching hospital.
Sample:
One hundred and twenty-two consecutive patients treated by hysteroscopic myomectomy for submucous leiomyoma over a period of almost eight years.
Methods:
Hysteroscopic electroresection of the leiomyoama using a continuous flow resectoscope.
Main Outcome Measures:
The avoidance of further surgery and patient satisfaction.
Results:
The average age of the patients at the time of their surgery was 42.8 years. A total of 194 fibroids were removed. The mean follow up period was 2.3 years (range 1-7.6). Of those asked, 71.4% were satisfied with the results of surgery. Sixteen women required further surgery for fibroids, and six ultimately underwent hysterectomy. Survival analysis showed that the risk of further surgery was 21% at four years after the myomectomy, and 0% thereafter. Univariate regression analysis suggested that outcome was significantly better in older women, and in cases where the uterus was equivalent in size to < or = 6 weeks of gestation, the fibroid was < or = 3 cm in diameter and mainly intra-cavitary, and the procedure time was < or = 20 minutes. The influence of hormonal pre-treatment and the number of fibroids excised was not statistically significant. After multivariate regression analysis, only overall uterine size and the position of the fibroid being removed were found to significantly influence the success of surgery.
Conclusions:
Hysteroscopic myomectomy is an effective way to manage patients with symptomatic submucous leiomyomata, particularly when the uterus is not grossly enlarged and the fibroid(s) are mainly inside the uterine cavity.