Open AccessUterine‐sparing minimally invasive interventions in women with uterine fibroids: a systematic review and indirect treatment comparison meta‐analysis
Author(s) -
Panagiotopoulou Nikoletta,
Nethra Shankaralingaiah,
Karavolos Stamatios,
Ahmad Gaity,
Karabis Andreas,
Burls Amanda
Publication year - 2014
Publication title -
acta obstetricia et gynecologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.401
H-Index - 102
eISSN - 1600-0412
pISSN - 0001-6349
DOI - 10.1111/aogs.12441
Subject(s) - medicine , uterine artery embolization , uterine artery , odds ratio , uterine fibroids , confidence interval , embolization , meta analysis , randomized controlled trial , gynecology , obstetrics , surgery , pregnancy , gestation , biology , genetics
Objective To evaluate the effectiveness of uterine‐sparing interventions for women with symptomatic uterine fibroids who wish to preserve their uterus. Design Systematic review and indirect comparison meta‐analysis. Methods MEDLINE , EMBASE , CENTRAL , conference proceedings, trial registers and reference lists were searched up to October 2013 for randomized controlled trials. Main outcome measures Outcome measures were patient satisfaction, re‐intervention and complications rates, reproductive outcomes, and hospitalization and recovery times. Results Five trials, involving 436 women were included; two compared uterine artery embolization with myomectomy and three compared uterine artery embolization with laparoscopic uterine artery occlusion. Indirect treatment comparison showed that myomectomy and uterine artery embolization resulted in higher rates of patient satisfaction (odds ratio 2.56, 95% credible interval 0.56–11.75 and 2.7, 95% credible interval 1.1–7.14, respectively) and lower rates of clinical failure (odds ratio 0.29, 95% credible interval 0.06–1.46 and 0.37, 95% credible interval 0.13–0.93, respectively) than laparoscopic uterine artery occlusion. Myomectomy resulted in lower re‐intervention rate than uterine artery embolization (odds ratio 0.08, 95% credible interval 0.02–0.27) and laparoscopic uterine artery occlusion (odds ratio 0.08, 95% credible interval 0.01–0.37) even though the latter techniques had an advantage over myomectomy because of shorter hospitalization and quicker recovery. There was no evidence of difference between the three techniques in ovarian failure and complications rates. The evidence for reproductive outcomes is poor. Conclusion Our study's results suggest that laparoscopic uterine artery occlusion is less effective than uterine artery embolization and myomectomy in treatment of symptomatic fibroids. The choice between uterine artery embolization and myomectomy should be based on individuals' expectations and fully informed discussion.