Randomised comparison of uterine artery embolisation (UAE) with surgical treatment in patients with symptomatic uterine fibroids (REST trial): 5-year results

Moss, J.G., Cooper, K.G., Khaund, A., Murray, L., Murray, G.D., Wu, O. , Craig, L.E. and Lumsden, M.A. (2011) Randomised comparison of uterine artery embolisation (UAE) with surgical treatment in patients with symptomatic uterine fibroids (REST trial): 5-year results. BJOG: An International Journal of Obstetrics and Gynaecology, 118(8), pp. 936-944. (doi: 10.1111/j.1471-0528.2011.02952.x)

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Abstract

Objective: To compare the long-term results of uterine artery embolisation (UAE) with surgery for women with symptomatic uterine fibroids. Design Pragmatic, open, multicentre, randomised trial. Setting Twenty-seven participating UK secondary care centres. Sample: Women aged >= 18 years with symptomatic fibroids who were considered to justify surgical treatment. Methods: In total, 157 women were randomised (in a 2:1 ratio): 106 to UAE and 51 to surgery (hysterectomy 42; myomectomy nine). Main outcome measures Quality of life at 5 years, as assessed by the Short Form General Health Survey (SF-36). Secondary measures included complications, adverse events and the need for further intervention. Results: There were no significant differences between groups in any of the eight components of the SF-36 scores at 5 years (minimum P = 0.45). Symptom score reduction and patient satisfaction with either treatment was very high, with no group difference. Rates of adverse events were similar in both groups (19% embolization and 25% surgery; P = 0.40). The 5-year intervention rate for treatment failure or complications was 32% (UAE arm) and 4% (surgery arm), respectively. The initial cost benefit of UAE over surgery at 12 months was substantially reduced because of subsequent interventions, with treatments being cost neutral at 5 years. Conclusions: We have found that UAE is a satisfactory alternative to surgery for fibroids. The less invasive nature of UAE needs to be balanced against the need for re-intervention in almost a third of patients. The choice should lie with the informed patient.

Item Type:Articles
Additional Information:The definitive version is available at www3.interscience.wiley.com.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Lumsden, Professor Mary and Craig, Dr Louise and Wu, Professor Olivia
Authors: Moss, J.G., Cooper, K.G., Khaund, A., Murray, L., Murray, G.D., Wu, O., Craig, L.E., and Lumsden, M.A.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Health Economics and Health Technology Assessment
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:BJOG: An International Journal of Obstetrics and Gynaecology
Publisher:Wiley-Blackwell Publishing Ltd.
ISSN:1470-0328
ISSN (Online):1471-0528
Copyright Holders:Copyright © 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology 2011 © RCOG
First Published:First published in Clinical Endocrinology 2011 118(8):936-944
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
439131Long term (3-5 years) follow up and MRI imaging of the REST cohort trialMary LumsdenScottish Executive Health Department (SEHHD-CSO)CZB/4/484MVLS MED - REPRODUCTIVE & MATERNAL MED