Myomectomy Yields Slightly Better QOL Than Uterine-Artery Embolization

By Gene Emery

July 31, 2020

NEW YORK (Reuters Health) - Women who undergo traditional fibroid-removal surgery report a marginally better two-year health-related quality of life than women treated with uterine-artery embolization, the doctors behind the FEMME study of 254 women report.

But the difference was not dramatic and a comparable number of women in both groups subsequently gave birth, although the study was not powered to assess fertility among the women, whose average age was 41.

When given a 101-point quality-of-life questionnaire, where a higher score indicated more satisfaction, women in the myomectomy group logged a score of 84.6 compared with 80.0 among the women who underwent embolization (P=0.01).

"Both (techniques) improve the quality of life, although myomectomy is marginally better over embolization," said chief author Dr. Isaac Manyonda of St. George's Hospital and Medical School in London.

The rates of perioperative and postoperative complications were 29% with surgery and 24% with embolization. Although uterine-artery embolization usually requires a shorter stay in the hospital and faster recovery, it carries a higher risk of requiring another intervention.

The new results show that "now we have two uterus-preserving treatment options that are effective at preserving the quality of life in women," Dr. Manyonda said.

"As far as we can tell, allowing for these numbers that are not large enough, both treatments allow women to get pregnant, and this is very important because of the historical concerns gynecologists have had about embolization," he told Reuters Health by phone.

"The FEMME trial is among the first major trials to evaluate alternatives to hysterectomy that included an assessment of the intention for pregnancy and that enrolled women in whom future pregnancy was desired; as such, it is a big step forward," Dr. Elizabeth Stewart of the Mayo Clinic, in Rochester, Minnesota, writes in an editorial in the New England Journal of Medicine, where the study appears.

The test was done at 29 hospitals in the United Kingdom among women who wanted to avoid a hysterectomy. They were enrolled from 2012 to 2015.

At the two-year mark, 93% said they would recommend the procedure to a friend versus 84% of the uterine-artery embolism patients.

However, "the percentages of women who indicated that they would be willing to undergo the procedure again were 78% and 74%, respectively," the researchers said.

In the myomectomy group, five women reported getting pregnant, with four live births resulting. There were nine pregnancies within two years in the embolization group, with six live births.

To definitively resolve the fertility question would be a challenge "because the numbers we'd need would be quite large," said Dr. Manyonda.

Ultimately, 16% of the embolization patients and 7% of women who received a myomectomy had at least one additional fibroid-related procedure.

Dr. Manyonda, a professor of obstetrics and gynecology at St. George's, estimated that when patients weigh the pros and cons of the two procedures, the decision is roughly a 50-50 split.

Dr. Manyonda said data comparing the relative costs of the two procedures is being analyzed.

One problem with the study: "19% of the participants did not return the primary outcome questionnaire at two years," the researchers said.

SOURCE: https://bit.ly/2WXvQ4Z https://bit.ly/2WXvQ4Z; The New England Journal of Medicine, online July 29, 2020.

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