Predictors of surgical outcomes in transcervical resection of myoma

To verify identified predictors of surgical outcomes in transcervical resection of myoma (TCRM) in Filipino women.

A retrospective analytical cross-sectional study was done on 474 women who underwent TCRM between 2010 and 2020, in St Luke's Medical Center, Philippines. Ethical exemption was granted by the Institutional Ethics Committee. Identified predictors of prolonged operative time (>60 min)-increased blood loss (>70 mL), fluid overload, uterine perforation, and incomplete resection-in published research studies were analyzed.

Univariate analysis revealed that European Society for Gynecological Endoscopy (ESGE) type 2, and myoma size ≥5 cm, myoma number ≥3 were associated with prolonged operative time. ESGE type 2 and myoma size ≥5 cm were associated with increased blood loss and incomplete resection. Myoma size ≥5 cm, an intraoperative fluid deficit of 1000 mL (hypotonic) or 2500 mL (isotonic), and prolonged operative time were correlated with fluid overload. ESGE type 2 is associated with uterine perforation. Only a Lasmar score ≥5 was significantly associated with all the aforementioned unfavorable surgical outcomes. Multivariate analysis showed that a Lasmar score ≥5 (odds ratio [OR] 6143.26; 95% confidence interval [CI] 456-82 680; P < 0.001) and myoma size ≥5 cm (OR 21.56; 95% CI 1.67-277; P = 0.019) were independent predictors of adverse surgical outcomes.

This study verified that the Lasmar classification can predict TCRM complexity with cut-off values of 5 for both Lasmar score and myoma size. We recommend that the use of the Lasmar scoring classification preoperatively may be beneficial in TCRM in Filipino women.