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Embolisation is a good alternative to surgery for fibroids

Q Is uterine artery embolisation as safe and effective as surgical treatments for symptomatic uterine fibroids?

Q Is uterine artery embolisation as safe and effective as surgical treatments for symptomatic uterine fibroids?

Synopsis

Although hysterectomy is still commonly performed for women with symptomatic uterine fibroids, myomectomy and uterine artery embolisation are alternatives that are less invasive and allow a woman to maintain her fertility.

In this randomised, non-blinded controlled trial, 157 women at 27 hospitals in the UK were randomised in a 2:1 ratio to either uterine artery embolisation or surgery (either myomectomy or hysterectomy, at the patient's discretion, depending on her desire for future fertility).

Groups were balanced at the start of the study, other than a slightly greater baseline quality of life in the embolisation group. Analysis was by intention to treat and adjusted for baseline quality of life values. The primary outcome was quality of life as measured by the Medical Outcomes Study 36-Item Short-Form General Health Survey (SF-36) and EuroQOL scores at one and 12 months.

The only differences for all subscales at both time points in both quality of life scores was a faster recovery of physical function, physical role, and social function at one month with embolisation. Length of stay was shorter (one vs five days) and return to work faster for embolisation, as well.

After a year the symptom score (different from the quality of life scores) was more improved in the surgical group, although the difference was of borderline clinical significance (0.7 points on a 11-point scale). Major adverse events were non-significantly more common in the surgery group (20% vs 12%; P = .22), but 20% of patients undergoing embolisation required a subsequent invasive procedure because of treatment failure.

Level of evidence

1b- = Individual randomised controlled trials (with a wide confidence interval).

Bottom line

Uterine artery embolisation is a reasonable alternative to more invasive surgical procedures. Outcomes are not quite as good as with surgery, and retreatment is needed for about one in five women, although recovery is faster and the cost lower. Major adverse events were more common in the surgery group (20% vs 12%), although this difference wasn't statistically significant.

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