Comparison of surgery alone and combined surgical-medical treatment in the management of symptomatic uterine adenomyoma

Wang, Peng Hui; Liu, Wei Min; Fuh, Jong Ling; Cheng, Ming Huei; Chao, Hsiang Tai

doi:10.1016/j.fertnstert.2008.07.1744

Cited by 110 publications

(120 citation statements)

References 59 publications

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“…Moreover, a recent study demonstrated that conservative surgery with a 6-course of GnRH agonist provided an effective treatment option for long-term symptom control after a 3-year follow-up [10]. Our results differ from those of Wang et al [9], who reported that surgical-medical treatment provided more effective symptom control than surgery alone. In this study, therapeutic outcomes were similar between the surgical-medical treatment and surgery alone during the entire follow-up period.…”

Section: Discussioncontrasting

confidence: 99%

“…Wang et al [9] published the largest cases series of cytoreductive surgery and compared the outcomes of 165 women treated with surgery alone to women treated with surgery in combination with a postoperative 6-course GnRH agonist therapy. Both groups showed a significant reduction of symptoms at 2 years; however, the symptom relapse rates in the surgical-medical group were significantly lower than those in the surgery-alone group [9]. Moreover, a recent study demonstrated that conservative surgery with a 6-course of GnRH agonist provided an effective treatment option for long-term symptom control after a 3-year follow-up [10].…”

Section: Discussionmentioning

confidence: 99%

“…This procedure effectively relieves dysmenorrhea and menorrhagia [6,7,8]. One recent study showed that postoperative GnRH agonist administration reduces the recurrence of symptoms such as menorrhagia or dysmenorrhea [9]. However, little long-term data on symptom relapse after adenomyomectomy are available [9,10].…”

Section: Introductionmentioning

confidence: 99%

“…One recent study showed that postoperative GnRH agonist administration reduces the recurrence of symptoms such as menorrhagia or dysmenorrhea [9]. However, little long-term data on symptom relapse after adenomyomectomy are available [9,10]. The symptom relapse rate after conservative surgical management varies from 1.8 to 49.0% [9,10], and the long-term effects of conservative surgical treatment for symptomatic adenomyosis are unclear.…”

Section: Introductionmentioning

confidence: 99%

“…However, little long-term data on symptom relapse after adenomyomectomy are available [9,10]. The symptom relapse rate after conservative surgical management varies from 1.8 to 49.0% [9,10], and the long-term effects of conservative surgical treatment for symptomatic adenomyosis are unclear. Therefore, the aims of this study were to determine the surgical outcomes and long-term efficacy of laparoscopic or robotic adenomyomectomy with uterine artery ligation for the treatment of severely symptomatic adenomyosis and evaluate the efficacy of postoperative GnRH agonist administration for preventing symptom recurrence.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Long-Term Efficacy of Laparoscopic or Robotic Adenomyomectomy with or without Medical Treatment for Severely Symptomatic Adenomyosis

Chong

Lee

Hong

et al. 2016

Gynecol Obstet Invest

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Background/Aims: To determine the long-term efficacy of laparoscopic or robotic adenomyomectomy with or without gonadotropin-releasing hormone (GnRH) for the treatment of severely symptomatic adenomyosis. Methods: Between August 2008 and May 2011, we prospectively observed 33 patients who underwent laparoscopic or robotic adenomyomectomy with uterine artery ligation for the treatment of symptomatic adenomyosis. Seventeen patients (52%) received 3-course GnRH agonist treatment after the adenomyomectomy. Results: The mean operating time was 147.4 ± 52.0 min, and the mean blood loss was 36.1 ± 37.4 ml. Postoperative complications occurred in 5 patients, including 4 cases of febrile morbidity, 1 case of ileus and 1 case of pelvic abscess. Patients had statistically significant symptom relief during the 3-year follow-up period. Four of the 33 patients (12%) showed symptom relapse; 3 patients showed a relapse with dysmenorrhea and 1 patient showed a relapse with menorrhagia. There were no significant differences in terms of therapeutic outcomes between surgical-only and surgical-medical treatment. Conclusion: Laparoscopic or robotic adenomyomectomy was feasible and safe for women with severely symptomatic adenomyosis who requested uterine preservation. Moreover, this procedure provided long-term symptom control, regardless of postoperative GnRH agonist administration.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Long-Term Efficacy of Laparoscopic or Robotic Adenomyomectomy with or without Medical Treatment for Severely Symptomatic Adenomyosis

Chong

Lee

Hong

et al. 2016

Gynecol Obstet Invest

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Adjuvant therapy in conservative surgery for adenomyosis

Chao

Song

et al. 2021

Intl J Gynecology & Obste

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Objective To investigate the significance of perioperative levonorgestrel‐releasing intrauterine system (LNG‐IUS) and/or gonadotropin‐releasing hormone agonists (GnRHa) as adjuvant therapy in preventing recurrences or progression of diseases. Methods Medical records were collected from patients diagnosed with adenomyosis who underwent uterus‐sparing surgeries from March 1, 2012 to December 31, 2018. The associations of perioperative adjuvant therapy with recurrence of disease and symptoms were analyzed with the Kaplan–Meier method and proportional hazards models with hazard ratios (HRs) and 95% confidence intervals (CIs). Results A total of 322 eligible patients were included, of whom 173 (58.1%) received perioperative adjuvant therapy. Perioperative adjuvant therapy (HR 0.44, 95% CI 0.22–0.91, P = 0.022) and perioperative GnRHa therapy (HR 0.48, 95% CI 0.24–0.99, P = 0.042) significantly reduced disease recurrence. No patient using perioperative LNG‐IUS therapy experienced recurrence. In the multivariate analysis, increased age (>35 years at surgery) was the only risk factor for disease recurrence (HR 2.35, 95% CI 1.01–5.45, P = 0.047). Conclusion Perioperative adjuvant therapy with GnRHa and/or the LNG‐IUS can significantly reduce disease recurrence or progression for adenomyosis patients undergoing uterus‐sparing surgery. Older patients are more likely to experience disease recurrence.

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Comparison of recurrence rate and risk factors in patients with focal adenomyosis with and without medical treatment after conservative surgery

Wang

Zhang

et al. 2022

Intl J Gynecology & Obste

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Comparison of surgery alone and combined surgical-medical treatment in the management of symptomatic uterine adenomyoma

Cited by 110 publications

References 59 publications

Long-Term Efficacy of Laparoscopic or Robotic Adenomyomectomy with or without Medical Treatment for Severely Symptomatic Adenomyosis

Long-Term Efficacy of Laparoscopic or Robotic Adenomyomectomy with or without Medical Treatment for Severely Symptomatic Adenomyosis

Adjuvant therapy in conservative surgery for adenomyosis

Comparison of recurrence rate and risk factors in patients with focal adenomyosis with and without medical treatment after conservative surgery

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