Uterine Artery Embolisation for Women with Giant Versus Non-giant Uterine Fibroids: A Systematic Review and Meta-analysis.

Abstract

Evidence supporting uterine artery embolisation (UAE) for giant fibroids (≥ 10cm and/or uterine volume ≥ 700CC) remains sparse. We performed a systemic review and meta-analysis of UAE outcomes for symptomatic giant versus non-giant fibroids. The literature was systematically reviewed. Research studies of UAE as an adjunct to surgery, and those not using peri-operative MRI were excluded. Primary outcomes were fibroid size and uterine volume reduction, procedure time, length of hospital stay, reinterventions, patient symptom improvement/satisfaction and complications. We identified four observational studies (839 patients; giant = 163, non-giant = 676). Both groups demonstrated reduction in fibroid size and uterine volume after UAE, with equivocal difference in uterine volume reduction (Mean difference (MD) - 0.3 95% confidence interval (CI) - 3.8 to 3.1, p = 0.86) and greater reduction in non-giant dominant fibroid size (MD - 5.9 95% CI - 10.3 to - 1.5, p < 0.01). Giant fibroids were associated with 5.6min longer mean operative time (MD 5.6min 95% CI 2.6-8.6, p < 0.01) and 4.8h longer mean hospital stay (MD 4.8h 95% CI 1.1-8.6, p = 0.01). Patient symptoms/satisfaction outcomes were summarised, but too heterogeneous for meta-analysis. Major complication and reintervention rates were low, with a statistically higher rate of major complications (Odds ratio (OR) 4.7 95% CI 1.5-14.6, p < 0.01) and reinterventions (OR 3.6 95% CI 1.7-7.5, p < 0.01) in giant fibroids. Current evidence shows UAE is a safe and effective option to treat giant fibroids. However, the limited available data indicate a relatively higher risk of complications and reinterventions when compared with non-giant fibroids. Patients should be selected, counselled and managed accordingly. Level III, Systematic review of retrospective cohort studies.