Uterine-Artery Embolization or Myomectomy for Uterine Fibroids

Manyonda, Isaac; Belli, Anna Maria; Lumsden, Mary Ann; Moss, Jonathan; McKinnon, William; Middleton, Lee J.; Cheed, Versha; Wu, Olivia; Sirkeci, Fusun; Daniels, Jane P.; McPherson, Klim

Abstract

Copyright © 2020 Massachusetts Medical Society. BACKGROUND: Uterine fibroids, the most common type of tumor among women of reproductive age, are associated with heavy menstrual bleeding, abdominal discomfort, subfertility, and a reduced quality of life. For women who wish to preserve their uterus and who have not had a response to medical treatment, myomectomy and uterine-artery embolization are therapeutic options. METHODS: We conducted a multicenter, randomized, open-label trial to evaluate myomectomy, as compared with uterine-artery embolization, in women who had symptomatic uterine fibroids and did not want to undergo hysterectomy. Procedural options included open abdominal, laparoscopic, or hysteroscopic myomectomy. The primary outcome was fibroid-related quality of life, as assessed by the score on the health-related quality-of-life domain of the Uterine Fibroid Symptom and Quality of Life (UFS-QOL) questionnaire (scores range from 0 to 100, with higher scores indicating a better quality of life) at 2 years; adjustment was made for the baseline score. RESULTS: A total of 254 women, recruited at 29 hospitals in the United Kingdom, were randomly assigned: 127 to the myomectomy group (of whom 105 underwent myomectomy) and 127 to the uterine-artery embolization group (of whom 98 underwent embolization). Data on the primary outcome were available for 206 women (81%). In the intention-to-treat analysis, the mean (±SD) score on the health-related quality-of-life domain of the UFS-QOL questionnaire at 2 years was 84.6±21.5 in the myomectomy group and 80.0±22.0 in the uterine-artery embolization group (mean adjusted difference with complete case analysis, 8.0 points; 95% confidence interval [CI], 1.8 to 14.1; P = 0.01; mean adjusted difference with missing responses imputed, 6.5 points; 95% CI, 1.1 to 11.9). Perioperative and postoperative complications from all initial procedures, irrespective of adherence to the assigned procedure, occurred in 29% of the women in the myomectomy group and in 24% of the women in the uterine-artery embolization group. CONCLUSIONS: Among women with symptomatic uterine fibroids, those who underwent myomectomy had a better fibroid-related quality of life at 2 years than those who underwent uterine-artery embolization. (Funded by the National Institute for Health Research Health Technology Assessment program; FEMME Current Controlled Trials number, ISRCTN70772394.).

Citation

Manyonda, I., Belli, A. M., Lumsden, M. A., Moss, J., McKinnon, W., Middleton, L. J., …McPherson, K. (2020). Uterine-Artery Embolization or Myomectomy for Uterine Fibroids. New England Journal of Medicine, 383(5), 440-451. https://doi.org/10.1056/NEJMoa1914735

• Journal Article Type: Article
• Acceptance Date: May 26, 2020
• Online Publication Date: Jul 30, 2020
• Publication Date: Jul 30, 2020
• Deposit Date: Jul 23, 2020
• Publicly Available Date: Jan 31, 2021
• Journal: The New England journal of medicine
• Print ISSN: 0028-4793
• Electronic ISSN: 1533-4406
• Publisher: Massachusetts Medical Society
• Peer Reviewed: Peer Reviewed
• Volume: 383
• Issue: 5
• Pages: 440-451
• DOI: https://doi.org/10.1056/NEJMoa1914735
• Keywords: General Medicine
• Public URL: https://nottingham-repository.worktribe.com/output/4782965
• Publisher URL: https://www.nejm.org/doi/10.1056/NEJMoa1914735