Uterine artery embolization vs hysterectomy in the treatment of symptomatic uterine fibroids: 10-year outcomes from the randomized EMMY trial

Autor: Annefleur M. de Bruijn, Sanne M. van der Kooij, Willem M. Ankum, Erwin Birnie, Nicole A. Volkers, Jim A. Reekers, Wouter J. K. Hehenkamp
Přispěvatelé: Health Psychology Research (HPR), Obstetrics and Gynaecology, Radiology and Nuclear Medicine, Other departments, Obstetrics and gynaecology, ICaR - Ischemia and repair
Rok vydání: 2016
Předmět:
SURGERY
Cost-Benefit Analysis
Health Status
medicine.medical_treatment
long-term follow-up
law.invention
0302 clinical medicine
Randomized controlled trial
Uterine artery embolization
QUALITY-OF-LIFE
law
Surveys and Questionnaires
randomized trial
INCONTINENCE IMPACT QUESTIONNAIRE
030212 general & internal medicine
Embolization
hysterectomy
Uterine artery
030219 obstetrics & reproductive medicine
Leiomyoma
Obstetrics
uterine artery embolization
WOMEN
Obstetrics and Gynecology
Middle Aged
Treatment Outcome
Patient Satisfaction
Retreatment
Uterine Neoplasms
Female
URINARY-INCONTINENCE
Adult
medicine.medical_specialty
Uterine fibroids
MENORRHAGIA
myoma
03 medical and health sciences
medicine.artery
medicine
Humans
uterine fibroids
Uterine Neoplasm
UROGENITAL DISTRESS INVENTORY
Hysterectomy
business.industry
Myoma
medicine.disease
Surgery
quality of life
business
Follow-Up Studies
Zdroj: American Journal of Obstetrics and Gynecology, 215(6):ARTN 745.e1-12. MOSBY-ELSEVIER
American journal of obstetrics and gynecology, 215(6), 745.e1-12. Mosby Inc.
American Journal of Obstetrics and Gynecology, 215. Mosby Inc.
de Bruijn, A M, Ankum, W M, Reekers, J A, Birnie, E, van der Kooij, S M, Volkers, N A & Hehenkamp, W J K 2016, ' Uterine artery embolization vs hysterectomy in the treatment of symptomatic uterine fibroids: 10-year outcomes from the randomized EMMY trial ', American Journal of Obstetrics and Gynecology, vol. 215, pp. 12 . https://doi.org/10.1016/j.ajog.2016.06.051
ISSN: 0002-9378
DOI: 10.1016/j.ajog.2016.06.051
Popis: BACKGROUND: Since 1995 uterine artery embolization has been described as an alternative for hysterectomy in patients with symptomatic fibroids. Many studies including several randomized controlled trials established uterine artery embolization as a valuable treatment. These randomized controlled trials reported outcomes in terms of health-related quality of life, clinical outcomes, efficacy, and cost-effectiveness after 1, 2, and 5 years of follow-up.OBJECTIVE: The purpose of this study was to compare clinical outcome and health-related quality of life 10 years after uterine artery embolization or hysterectomy in the treatment of heavy menstrual bleeding caused by uterine fibroids in a randomized controlled trial.STUDY DESIGN: In all, 28 Dutch hospitals recruited patients with symptomatic uterine fibroids who were eligible for hysterectomy. Patients were 1:1 randomly assigned to uterine artery embolization or hysterectomy. The outcomes assessed at 10 years postintervention were reintervention rates, health-related quality of life, and patient satisfaction, which were obtained through validated questionnaires. Study outcomes were analyzed according to original treatment assignment (intention to treat).RESULTS: A total of 177 patients were randomized from 2002 through 2004. Eventually 81 uterine artery embolization and 75 hysterectomy patients underwent the allocated treatment shortly after randomization. The remaining patients withdrew from the trial. The 10-year questionnaire was mailed when the last included patient had been treated 10 years earlier. The mean duration of follow-up was 133 months (SD 8.58) accompanied by a mean age of 57 years (SD 4.53). Questionnaires were received from 131 of 156 patients (84%). Ten years after treatment, 5 patients underwent secondary hysterectomy resulting in a total of 28 of 81 (35%) (24/77 [31%] after successful uterine artery embolization). Secondary hysterectomies were performed for persisting symptoms in all cases but 1 (for prolapse). After the initial treatment health-related quality of life improved significantly. After 10 years, generic health-related quality of life remained stable, without differences between both groups. The urogenital distress inventory and the defecation distress inventory showed a decrease in both groups, probably related to increasing age, without significant differences between study arms. Satisfaction in both groups remained comparable. The majority of patients declared being (very) satisfied about the received treatment: 78% of the uterine artery embolization group vs 87% in the hysterectomy group.CONCLUSION: In about two thirds of uterine artery embolization-treated patients with symptomatic uterine fibroids a hysterectomy can be avoided. Health-related quality of life 10 years after uterine artery embolization or hysterectomy remained comparably stable. Uterine artery embolization is a well-documented and less invasive alternative to hysterectomy for symptomatic uterine fibroids on which eligible patients should be counseled.
Databáze: OpenAIRE
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