Analysis of the risk factors for postoperative residue, relapse following myomectomy

Abstract

To elaborate the risk factors for leiomyoma residue and relapse after different approaches of myomectomy. From Jan. 2005 to Dec. 2010 and Jan. 2011 to Jan. 2013, 769 patients underwent myomectomy were recruited in Beijing Obstetrics and Gynecology Hospital. The patients demographic, leiomyoma characteristics, preoperative gonadotropin-releasing hormone agonist (GnRH-a) therapy, surgical approach, pathological type, follow-up information were collected. Leiomyoma number was the risk factor of postoperative residue and relapse, with the leiomyoma number increased one, the risk of residue and relapse increase 1.085 times (OR = 1.085, 95% CI: 1.019-1.154, P = 0.010), 1.043 times (RR = 1.043, 95% CI: 1.014-1.073, P = 0.003) respectively. Leiomyoma type (intramural leiomyoma) was the risk factor of relapse (RR = 1.665, 95% CI: 1.029-2.693, P = 0.038). Age was not the risk factor for postoperative residue rate (P = 0.828) and relapse rate (P = 0.193). GnRH- a didn't increase the postoperative residue and relapse rate (P = 0.542, 0.133). The postoperative residue rate (P = 0.764), relapse rate (P = 0.279) between transabdominal and laparoscopic myomectomy groups had no significant difference. Bizarre leiomyoma (RR = 5.678, 95% CI: 1.373-23.490, P = 0.017) and celluar leiomyoma (RR = 2.201, 95% CI: 1.466-3.303, P < 0.01) were the risk factors for postoperative relapse rate. Leiomyoma number, leiomyoma type (intramural leiomyoma) are the main risk factors for postoperative relapse. Pretreatment of GnRH-a and laparoscopic approach wouldn't increase the rate of residue and relapse. Bizarre leiomyoma and cellular leiomyoma have a higher relapse rate than common leiomyoma.