Risk of recurrence of uterine leiomyomas following laparoscopic myomectomy compared with open myomectomy

Ming, Xiu; Ran, Xu Ting; Li, Na; Nie, Dan; Li, Zheng Yu

doi:10.1007/s00404-019-05399-z

Cited by 15 publications

(6 citation statements)

References 26 publications

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“…Ming et al [ 32 ] performed a multicenter cohort study with a meta-analysis aimed to determine the risk of recurrence of UF after laparoscopic and open myomectomy. In a cohort study including 396 patients (83 patients who underwent laparoscopic and 313 patients who underwent open myomectomy), a similar recurrence rate was observed between laparoscopic and open myomectomy.…”

Section: Resultsmentioning

confidence: 99%

Fibroid Removal after Myomectomy: An Overview on the Problems of Power Morcellation

Sparić

Andjić

D’Oria³

et al. 2022

Healthcare

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The authors reviewed uterine fibroid (UF) morcellation and its potential consequences, notably a hypothetical spread and dissemination of occult uterine leiomyosarcoma (LMS) tissue, evaluating the effect of laparoscopic versus open myomectomies with and without morcellation on patients’ outcomes, as well as related medical-legal issues. MEDLINE and PubMed search was performed for the years 1990–2021, using a combination of keywords on this topic. Relevant articles were identified and included in this narrative review. There is an individual risk, for all patients, for LMS diagnosis after myomectomy. However, the risk for occult LMS diagnosis during a laparoscopic myomectomy is generally reduced when the guidelines of scientific societies are followed, with an overall benefit from the laparoscopic approach with morcellation in appropriate cases. Gynecological societies do not ban morcellation and laparoscopic hysterectomy/myomectomy per se, but recommend their use on the basis of the patients’ clinical characteristics. It is suggested for gynecologists to provide detailed information to patients when obtaining an informed consent for open or laparoscopic hysterectomy/myomectomy. A detailed preoperative assessment of patients and the risk benefit ratio of laparoscopic morcellation of uterine mass could overcome the “a priori” banning of the morcellation technique.

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Section: Resultsmentioning

confidence: 99%

Fibroid Removal after Myomectomy: An Overview on the Problems of Power Morcellation

Sparić

Andjić

D’Oria³

et al. 2022

Healthcare

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“…Certain studies do indicate a higher risk of recurrence with laparoscopy versus open technique, although data is conflicting. 27 , 28 …”

Section: Discussionmentioning

confidence: 99%

Predictors of Minimally Invasive Myomectomy in the National Inpatient Sample Database, 2010–2014

Frost¹,

McMahon²,

Smith³

et al. 2021

JSLS

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Background and Objectives: This study aims to characterize the utilization of minimally invasive myomectomy in the United States and to identify the patient and hospital factors associated with surgical approach to myomectomy. Methods: This is a cross-sectional study using the National Inpatient Sample database. We extracted women aged 18–50 years who underwent open and minimally invasive (laparoscopic and robotic) myomectomy (MIM) from January 1, 2010–December 31, 2014. Descriptive statistics were obtained for patient and hospital characteristics. We then performed multivariable logistic regression to examine the association of patient (age, race, insurance status, median household income) and hospital (bed size, teaching status, for-profit status, census region, cases volume) characteristics with the likelihood of undergoing MIM. Results: Of 114,850 myomectomy cases, 8,330 (7%) underwent MIM and 106,520 (93%) were open. Over time, the proportion of MIM remained very low and slightly decreased from 8.2% in 2010 to 6.1% in 2014 (p-for-trend: 0.001). Most hospitals performed few MIM per year, with 50% performing five or less, and 25% performing three or fewer per year. African American, Hispanic, and women of other races were less likely to undergo MIM compared to Caucasian women (adjusted odds ration [OR] 0.57, 95% confidence interval [CI] 0.50–0.64; 0.71, 95% CI 0.60–0.83; 0.62, 95% CI 0.52–0.74, respectively). Women in the West (adjusted odds ratio (aOR) 1.23, 95% CI 1.04–1.46) and Midwest (aOR 1.27, 95% CI 1.07–1.52) had higher odds of undergoing MIM. Conclusion: MIM appears to be an underutilized modality, accounting for less than10% of myomectomies. This underutilization disproportionally affects minority women.

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“…This finding is supported by the results of a more recent retrospective cohort study, which did not show an increased recurrence rate with laparoscopic myomectomy versus an abdominal approach in patients with 1–3 uterine leiomyomas (31.3% versus 34.2%, P =.571) (78). However, in a separate meta-analysis of existing literature, the authors found an increased recurrence rate with laparoscopic myomectomy in patients with more than five leiomyomas (OR, 1.50; 95% CI, 1.14–1.97) (78). Another retrospective cohort study also showed an increased cumulative risk of recurrence with laparoscopic myomectomy (76.2%) compared with an abdominal approach (63.4%) at 8-year follow up (relative risk [RR], 1.67; 95% CI, 1.27–2.21); however, the study groups were not matched for important confounding variables, such as number and size of leiomyomas and use of GnRH agonists, which may have influenced the results (79).…”

Section: Clinical Considerations and Recommendationsmentioning

confidence: 60%

Management of Symptomatic Uterine Leiomyomas

2021

Obstetrics &Amp; Gynecology

126

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Uterine leiomyomas (fibroids) are the most common solid and symptomatic neoplasm in women. They are the leading indication for hysterectomy (1, 2), which is a definitive and effective surgical treatment for leiomyoma. However, many patients benefit from and seek out management options other than hysterectomy because they desire future childbearing or wish to retain their uterus. The purpose of this Practice Bulletin is to provide updated evidence-based recommendations for the medical, procedural, and surgical management of symptomatic leiomyomas. Discussion of the use of morcellation in the surgical management of leiomyomas is beyond the scope of this document and is addressed in a separate American College of Obstetricians and Gynecologists (ACOG) publication (3).

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Risk of recurrence of uterine leiomyomas following laparoscopic myomectomy compared with open myomectomy

Cited by 15 publications

References 26 publications

Fibroid Removal after Myomectomy: An Overview on the Problems of Power Morcellation

Fibroid Removal after Myomectomy: An Overview on the Problems of Power Morcellation

Predictors of Minimally Invasive Myomectomy in the National Inpatient Sample Database, 2010–2014

Management of Symptomatic Uterine Leiomyomas

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