Lower long-term reintervention risk with myomectomy vs. other uterine fibroid procedures

Key takeaways:

• Reintervention rates were higher for hysteroscopic myomectomy, uterine artery embolization and endometrial ablation vs. myomectomy.
• Reintervention rates varied by age and parity for all methods but myomectomy.

Women treated for uterine fibroids had greater risks for long-term reintervention after uterine artery embolization, endometrial ablation and hysteroscopic myomectomy vs. abdominal, laparoscopic or vaginal myomectomy, researchers reported.

“The sparse evidence on long-term outcomes [for leiomyoma treatments], specifically in Black patients, constitutes a major gap; preliminary data suggest that Black patients may have higher posttreatment rates of leiomyoma recurrence than white patients,” Susanna D. Mitro, PhD, research scientist in the division of research at Kaiser Permanente, and colleagues wrote in Obstetrics & Gynecology.

Mitro and colleagues identified 10,324 women aged 18 to 50 years who underwent a first uterus-preserving uterine fibroid procedure from 2009 to 2021 using data from Kaiser Permanente Northern California electronic health records. Uterus-preserving procedures included hysteroscopic myomectomy, endometrial ablation, uterine artery embolization and abdominal, laparoscopic or vaginal myomectomies. All women were followed until reintervention, defined as a second uterus-preserving procedure or hysterectomy more than 30 days after first procedure, or censoring.

Overall, 21.2% of women were Black, 19.9% were Asian, 21.3% were Hispanic, 32.5% were white and 5.2% were of other races and ethnicities.

During a median follow-up period of 3.8 years, 18% of women underwent hysteroscopic myomectomy, 16.2% underwent uterine artery embolization, 21.4% underwent endometrial ablation and 44.4% underwent vaginal myomectomy. Of women with reinterventions, 63.2% underwent hysterectomy, 19.2% underwent a second procedure of the same type and 17.6% underwent a second procedure of a different type.

The 1-year reintervention risk was 4.3% for myomectomy, 8% for uterine artery embolization, 13.5% for endometrial ablation and 15.9% for hysteroscopic myomectomy. By 7 years, reintervention risks increased to 20.6% for vaginal myomectomy, 26% for uterine artery embolization, 35.5% for endometrial ablation and 37% for hysteroscopic myomectomy.

Within the first year, compared with vaginal myomectomy, reintervention likelihood was three times higher for endometrial ablation (HR = 2.97; 95% CI, 2.33-3.79) and 82% higher for uterine artery embolization (HR = 1.82; 95% CI, 1.39-2.37). At 7 years, reintervention likelihood was twice as likely with endometrial ablation (HR = 2.27; 95% CI, 1.97-2.62) and 52% higher for uterine artery embolization (HR = 1.52; 95% CI, 1.3-1.78) compared with vaginal myomectomy.

Researchers observed no variations by BMI, race and ethnicity of Neighborhood Deprivation Index for any uterus-preserving procedure. However, uterine artery embolization, endometrial ablation and hysteroscopic myomectomy reintervention rates varied by age with greater reintervention rates among women aged 18 to 35 vs. 46 to 50 years. In addition, hysteroscopic myomectomy reintervention rates were 35% higher among parous vs. nulliparous women.

“Reintervention risk did not vary by BMI, race and ethnicity or Neighborhood Deprivation Index but did vary for some procedures by age and parity,” the researchers wrote. “Findings illustrate clinically meaningful long-term differences in reintervention rates after a first uterus-preserving treatment for leiomyomas.”