Conservative Treatment of Uterine Myomas: A Network Meta-Analysis of Randomized Controlled Studies

To comparatively evaluate the effectiveness of uterine artery embolization (UAE), high-intensity focused ultrasound (HIFU), radiofrequency ablation treatment (RFT), and laparoscopic/laparotomic surgery in the conservative treatment of uterine fibroids.

The research was performed via electronic databases PubMed, Embase, and Cochrane Library, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards.

The network included 10 randomized trials between 2000 and 2024 and 1002 randomized subjects.

The network meta-analysis was conducted with subroutine netmeta on R. The risk of bias was assessed using the Revised Cochrane risk-of-bias tool for randomized trials. The surface under the cumulative ranking curve (SUCRA) was computed by Bayesian network meta-analysis. Incidences of reintervention per 100 person/year of follow-up were 4.13 (range, 0-19.4), 16.1 (6.2-32.8), 14.3 (0-15.1), and 6 (4.3-6.7) for myomectomy, UAE, HIFU, and RFT, respectively. The incidence rate ratios compared with myomectomy were 2.45 (95% confidence interval [CI], 1.38-4.37), 5.23 (95% CI, 1.59-17.3), and 4.59 (95% CI, 0.77-27.3; p = .09) for UAE, HIFU, and RFT, respectively. RTF had the highest (SUCRA, 1.25% and 3%) whereas myomectomy had the lowest risk of reintervention (SUCRA, 98% and 95%) or hysterectomy during follow-up (median, 12 months; range, 3-24). The risk of major complications was significantly lower after UAE (odds ratio, 0.38; 95% CI, 0.17-0.85) than myomectomy. The procedure with the lowest likelihood of major complications was HIFU (SUCRA, 81.5%). Finally, in the evaluation of QoL at follow-up visits, there were no differences between the treatments studied, although the model was highly heterogeneous and inconsistent.

In the analysis of randomized trials, surgical myomectomy carried the least risk of reintervention and subsequent hysterectomy during a relatively short follow-up period. HIFU was the method with the lowest risk of major complications.