Fibroid recurrence and symptom improvement in 127 patients having undergone abdominal myomectomy

Abstract

Objective: 1) To characterize preoperative and intraoperative risk factors for fibroid recurrence and requirement for subsequent surgical procedures, and 2) assess patient symptom improvement and satisfaction after having undergone abdominal myomectomy. Design: Retrospective cohort review with follow-up questionnaire survey. Materials and Methods: The medical records of 331 patients having undergone abdominal myomectomy by a single operator from March 1994 to November 2002 were reviewed. Questionnaires were sent to these patients assessing the patient’s recurrence of fibroids, requirement for additional surgical procedures attributed to fibroid recurrence, symptom improvement, and general patient satisfaction with having chosen abdominal myomectomy as a modality to treat their fibroids. Potential parameters influencing outcome measures were collected from the medical record and included race, age, abdominal myomectomy: questionnaire response interval (number of years), number of fibroids, total fibroid weight, largest fibroid, prior abdominal myomectomy, uterine size, and patient weight. Results: A total of 331 questionnaires were mailed to patients. Forty questionnaires did not reach the intended patient and were returned to the author with insufficient address. A total of 291 questionnaires were assumed to have reached patients, and 127 were returned completed (43.6% response rate). Overall, 19.7% of patients had been told by their physician that their fibroids had returned, and 4.7% of patients underwent an additional procedure secondary to recurrence of their fibroids. Symptoms were noted as “much improved” in 90.6% of patients, and 86.6% of patients were “very satisfied” with having chosen abdominal myomectomy as a modality to treat their uterine fibroids. In order to determine statistical significance among risk factors and outcome measures, Fisher exact tests were applied to the data comparisons. Univariate analysis demonstrated that women greater than 40 years of age were more likely to report symptoms as much improved as compared to patients less than forty years of age (95% vs. 80%, p<0.01). The number of fibroids at abdominal myomectomy significantly impacted the risk of fibroid recurrence. Women with greater than 10 fibroids at abdominal myomectomy reported fibroid recurrence in 38% of cases versus only 12% of women with less than or equal to 10 fibroids (p<0.01). The incidence of fibroid recurrence was reported as 7% in the first two years after abdominal myomectomy, and the incidence sharply rose after two years to 29% (p<0.01). Conclusion: Abdominal myomectomy is an effective surgical treatment for women with symptomatic uterine fibroids. Significant symptom improvement is noted in women that have undergone abdominal myomectomy, most notably in women over the age of forty years. Fibroid recurrence is a concern for women that undergo a less than definitive procedure to treat their uterine fibroids. Women with less than ten fibroids at the time of initial abdominal myoemectomy have a reduced risk for recurrence as compared to women with greater than 10 fibroids.