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ORIGINAL RESEARCH |
From the Department of Obstetrics and Gynecology, Spaarne Hospital, Haarlem, and the Departments of Clinical Epidemiology and Biostatistics and Obstetrics and Gynecology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
Address reprint requests to: Mark H. Emanuel, MD, PhD Department of Obstetrics and Gynecology Spaarne Hospital PO Box 1644 2003 BR Haarlem The Netherlands E-mail: memanuel{at}knmg.nl
Objective: To analyze the efficacy of transcervical resection of submucous myomas and to identify prognostic factors for long-term results.
Methods: Two-hundred eighty-five women were treated with transcervical resection of submucous myomas without endometrial ablation. In case of incomplete resection a repeat procedure was offered. Long-term follow-up was obtained. Recurrence was defined as the need for further surgery. The relation of several variables with the outcome was analyzed using Cox proportional hazard regression analysis.
Results: Seventeen cases (6%) were lost to follow-up. The median follow-up was 46 months (range 1–104 months); for cases without recurrence median follow-up was 42 months (range 16–104 months). Forty-one (14.5%) patients had repeat surgery. An independent prognostic value of uterine size (P < .001) and number of submucous myomas (P < .001) for recurrence was noted. Twenty of 41 patients who had repeat surgery subsequently had a hysterectomy. None of the variables investigated predicted the need for hysterectomy. The surgery-free percentage of 165 patients with normal sized uteri and not more than two myomas was 94.3% (standard error ± 1.8%) at 2 years and 90.3% (± 3.0%) at 5 years.
Conclusion: Transcervical resection of submucous myomas is a safe and effective treatment for patients with a normal sized uterus and not more than two myomas. It is an acceptable alternative for selected other patients. The need for a combined endometrial ablation is questionable. Transcervical resection of submucous myomas will give patients a high chance of averting further surgery and should modify the way patients are counseled.
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