Comparative characteristics of women after surgical treatment for uterine fibroids including myomectomy and hysterectomy

• Alina V. Solovieva
• Ekaterina Yu. Aleynikova
• Tatyana A. Demura
• Maria A. Spitsyna
• Kristina A. Gulenkova

Abstract

The aim of the study was to clarify the factors influencing the choice of the scope of surgical treatment

of uterine fibroids in women of reproductive age.

Material and methods. A cross-sectional study was conducted, the medical documentation of women

of reproductive age (27–49 years) was analyzed at the clinical sites of the Department of Obstetrics and Gynecology with a course of perinatology at the Medical Institute of the Patrice Lumumba Peoples’ Friendship University of Russia to the gynecological departments of the Moscow City Clinical Hospital after V.M. Buyanov and City Clinical Hospital No. 29 named after N.E. Bauman for 2022–2023. 118 women with uterine fibroids who were referred for surgical treatment were examined. The studied cohort of patients consisted of two groups: 1^st group (n=88) – women who underwent myomectomy using various surgical approaches, 2^nd group (n=30) – women who underwent total or subtotal hysterectomy.

Results. The age of patients who underwent myomectomy was on average 40.6 years, they were on average 6.4 years younger than patients referred for hysterectomy (p<0.001). In the hysterectomy group, there were 2.4 times more obese patients (9/30%) (p<0.05), who were 2.6 times more likely to have heavy menstrual and abnormal uterine bleeding (9/30%) (p<0.05), while more than half (16/55.33%) had multiple uterine fibroids (p<0.05), and the size of removed nodes was on average 0.55 cm larger (p<0.05), in contrast to patients who underwent organ-conserving surgery. In the group of women after myomectomy, the submucous location of uterine fibroids was more often determined – in 39/44.32% of patients (p<0.001). The study groups also differed in terms of reproductive function: 26/29.55% of women referred for myomectomy did not have children; in the group of women after hysterectomy, 28/93.33% completed their reproductive function (p<0.05). The results of histological examination did not differ in the study groups (p>0.05).

Conclusion. The main factors influencing the extent of surgical treatment were the age of the patients and their reproductive plans, as well as the number of myomatous nodes, their size and location.

Keywords: uterine fibroids; myomectomy; hysterectomy

References

1. Babalola O., Gebben D., Tarver M.E., Sangha R., Roberts J., Price V. Patient preferences regarding surgical treatment methods for symptomatic uterine fibroids. Ther Innov Regul Sci. 2023; 57 (5): 976–86.

2. Giuliani E., As-Sanie S., Marsh E.E. Epidemiology and management of uterine fibroids. Int J Gynaecol Obstet. 2020; 149 (1): 3–9.

3. Li B., Wang F., Chen L., Tong H. Global epidemiological characteristics of uterine fibroids. Arch Med Sci. 2023; 19 (6): 1802–10.

4. Rezk A., Kahn J., Singh M. Fertility Sparing Management in Uterine Fibroids. StatPearls Publishing, 2024. URL: http://www.ncbi.nlm.nih.gov/books/NBK574504/

5. Uimari O., Subramaniam K.S., Vollenhoven B., Tapmeier T.T. Uterine fibroids (Leiomyomata) and heavy menstrual bleeding. Front Reprod Health. 2022; 4: 818243.

6. Stewart E.A., Nowak R.A. Uterine fibroids: hiding in plain sight. Physiology (Bethesda). 2022; 37 (1): 16–27.

7. Yan W., Yuan S., Zhou D., Zhang M., Yang S., Wang W., et al. Status and treatment of patients with uterine fibroids in hospitals in central China: a retrospective study from 2018 to 2021. BMJ Open. 2024; 14 (1): e081736.

8. Leyland N., Leonardi M., Murji A., Singh S.S., Al-Hendy A., Bradley L. A call-to-action for clinicians to implement evidence-based best practices when caring for women with uterine fibroids. Reprod Sci. 2022; 29 (4): 1188–96.

9. Cianci S., Gulino F.A., Palmara V., La Verde M., Ronsini C., Romeo P. et al. Exploring surgical strategies for uterine fibroid treatment: a comprehensive review of literature on open and minimally invasive approaches. Medicina (Kaunas). 2023; 60 (1): 64.

10. Çinar M., Tokmak A., Güzel A.I., Aksoy R.T., Özer İ., Yilmaz N. et al. Association of clinical outcomes and complications with obesity in patients who have undergone abdominal myomectomy. J Chin Med Assoc. 2016; 79 (8): 435–9.

11. Reschke L., Afrin S., El Sabah M., Charewycz N., Miyashita-Ishiwata M, Borahay M.A. Leptin induces leiomyoma cell proliferation and extracellular matrix deposition via JAK2/STAT3 and MAPK/ERK pathways. F S Sci. 2022; 3 (4): 383–91.

12. Radynova S.B., Kenyaykina A.G., Lodyreva M.S., Turaeva M.A. The analysis of the main indications for surgical treatment of a uterine myoma for women with safe menstrual function. Sinergiya nauk [Synergy of Sciences]. 2019; (32): 1167–73. EDN VVIUSF. (in Russian)

13. Cao H., Li L., Yang B., Luo G., Lou J., Xi M. Unexpected uterine sarcomas after hysterectomy and myomectomy for presumed leiomyoma: a retrospective study of 26,643 patients. Cancer Manag Res. 2019; 11: 7007–74.

All articles in our journal are distributed under the Creative Commons Attribution 4.0 International License (CC BY 4.0 license)