Uterine-artery embolization versus surgery for symptomatic uterine fibroids

Edwards, R.D., Moss, J.G., Lumsden, M.A. , Wu, O. , Murray, L.S., Twaddle, S. and Murray, G.D. (2007) Uterine-artery embolization versus surgery for symptomatic uterine fibroids. New England Journal of Medicine, 356(4), pp. 360-370.

Abstract

<p><b>Background</b></p> <p>The efficacy and safety of uterine-artery embolization, as compared with standard surgical methods, for the treatment of symptomatic uterine fibroids remain uncertain.</p> <p><b>Methods</b></p> <p>We conducted a randomized trial comparing uterine-artery embolization and surgery in women with symptomatic uterine fibroids. The primary outcome was quality of life at 1 year of follow-up, as measured by the Medical Outcomes Study 36-Item Short-Form General Health Survey (SF-36).</p> <p><b>Results</b></p> <p>Patients were randomly assigned in a 2:1 ratio to undergo either uterine-artery embolization or surgery, with 106 patients undergoing embolization and 51 undergoing surgery (43 hysterectomies and 8 myomectomies). There were no significant differences between groups in any of the eight components of the SF-36 scores at 1 year. The embolization group had a shorter median duration of hospitalization than the surgical group (1 day vs. 5 days, P<0.001) and a shorter time before returning to work (P<0.001). At 1 year, symptom scores were better in the surgical group (P=0.03). During the first year of follow-up, there were 13 major adverse events in the embolization group (12%) and 10 in the surgical group (20%) (P=0.22), mostly related to the intervention. Ten patients in the embolization group (9%) required repeated embolization or hysterectomy for inadequate symptom control. After the first year of follow-up, 14 women in the embolization group (13%) required hospitalization, 3 of them for major adverse events and 11 for reintervention for treatment failure.</p> <p><b>Conclusions</b></p> <p>In women with symptomatic fibroids, the faster recovery after embolization must be weighed against the need for further treatment in a minority of patients.</p>

• Item Type: Articles
• Additional Information: In addition to the Writing Committee, the following investigators participated in the REST trial: Data and Trial Management: L.S. Murray (trial coordinator), H. Dewart, B. Ferrie, M. Khaund, L. Lawrie, D. Lyons, F. McLean. Data Monitoring Committee: I.T. Cameron (chair), H. Critchley, J. Reidy, P. Warner. Trial Management Committee: J.G. Moss (chair), R.D. Edwards, M.A. Lumsden, L.S. Murray (trial coordinator), G.D. Murray, S. Twaddle. Trial Steering Committee: J.G. Moss (chair), R.D. Edwards, M.A. Lumsden, L.S. Murray, G.D. Murray, S. Twaddle, C. West, I. Gillespie, M. Thomson, G. Houston, K. Cooper, P. Thorpe. The following centers and investigators (all in the United Kingdom) participated in the trial: Aberdeen Royal Infirmary, Aberdeen — K. Cooper, P. Thorpe; Bolton Royal Infirmary, Lancashire — J. Tuck; Murrayfield Hospital, Edinburgh — I. Gillespie; Crosshouse Hospital, Kilmarnock — G. Irvine; Eastern General Hospital, Edinburgh — C. Tay; Edinburgh Royal Infirmary — C. West, I. Gillespie; Falkirk Royal Infirmary, Falkirk — O. Prabu; Forth Park, Kirkcaldy — S. Pinion; Glasgow Royal Infirmary, Glasgow — M. Rodger, A. Reid; Hairmyres Hospital, Lanarkshire — K. Spowart; Hull Royal Infirmary, Hull — J. Killick, A. Nicholson; Inverclyde Hospital, Greenock — L. Cassidy; Monklands Hospital, Lanarkshire — V. Harper; Ninewells Hospital, Dundee — M. Thomson, G. Houston; Perth Royal Infirmary, Perth — D. Phillips; Queen Margaret’s Hospital, Dunfermline — S. Pinion; Raigmore Hospital, Inverness — L. Caird, D. Nicholls; Ross Hall BMI Hospital, Glasgow — J. Moss; St. John’s Hospital, Livingstone — P. Dewart; Southern General Hospital, Glasgow — M. Carty, G. Urqhuart; Stirling Royal Infirmary, Stirling — F. Morrison; Stobhill Hospital, Glasgow — M. Deeney; Vale of Leven Hospital, Alexandria — M. Haxton; and Western Infirmary, Glasgow — M.A. Lumsden, N. McMillan.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Twaddle, Dr Sara and Moss, Professor Jonathan and Murray, Dr Lilian and Lumsden, Professor Mary and Wu, Professor Olivia
• Authors: Edwards, R.D., Moss, J.G., Lumsden, M.A., Wu, O., Murray, L.S., Twaddle, S., and Murray, G.D.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Health Economics and Health Technology Assessment; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Centre for Population and Health Sciences; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Clinical Specialities
• Journal Name: New England Journal of Medicine
• Journal Abbr.: New Engl. J. Med.
• Publisher: Massachusetts Medical Society
• ISSN: 0028-4793
• ISSN (Online): 1533-4406