Manyonda, I. et al. (2020) Uterine-artery embolization or myomectomy for uterine fibroids. New England Journal of Medicine, 383(5), pp. 440-451. (doi: 10.1056/NEJMoa1914735) (PMID:32726530)
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Abstract
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).
| Item Type: | Articles |
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| Status: | Published |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | Moss, Professor Jonathan and Wu, Professor Olivia and Lumsden, Professor Mary |
| Authors: | Manyonda, I., Belli, A.-M., Lumsden, M.-A., Moss, J., McKinnon, W., Middleton, L. L., Cheed, V., Wu, O., Sirkeci, F., Daniels, J. P., and McPherson, K. |
| College/School: | College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health |
| Journal Name: | New England Journal of Medicine |
| Publisher: | Massachusetts Medical Society |
| ISSN: | 0028-4793 |
| ISSN (Online): | 1533-4406 |
| Copyright Holders: | Copyright © 2020 Massachusetts Medical Society |
| First Published: | First published in New England Journal of Medicine 383(5): 440-451 |
| Publisher Policy: | Reproduced in accordance with the publisher copyright policy |
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