Uterine Artery Embolization and Surgical Methods for the Treatment of Symptomatic Uterine Leiomyomas: A Systemic Review and Meta-analysis Followed by Indirect Treatment Comparison

Uterine Artery Embolization and Surgical Methods for the Treatment of Symptomatic Uterine Leiomyomas: A Systemic Review and Meta-analysis Followed by Indirect Treatment Comparison

Author Fonseca, Marcelo C. M. Autor UNIFESP Google Scholar
Castro, Rodrigo Autor UNIFESP Google Scholar
Machado, Marcio Google Scholar
Conte, Tania Google Scholar
Girao, Manoel J. B. C. Autor UNIFESP Google Scholar
Abstract Purpose: There is significant discussion and uncertainty about the optimal management of symptomatic uterine leiomyomas (SULs). Nonsurgical procedures such as uterine artery embolization (UAE) have been developed. The goal of this study was to conduct a meta-analysis and an indirect treatment comparison to examine the comparative efficacy and safety of the surgical procedures to treat SULs compared with UAE. Methods: MEDLINE, EMBASE, Lilacs, and the Cochrane Central Register of Controlled Trials data-bases were searched from inception to February 2016. Ten randomized controlled trials comparing UAE versus hysterectomy, myomectomy, and laparoscopic occlusion of the uterine arteries in patients with SUL published in a peer-reviewed journal were included. Two reviewers independently selected studies, assessed quality, and extracted data. Discrepancies were resolved through consensus. Findings: Data from 986 patients submitted to UEA (n = 527) or surgery (n = 459) were analyzed. UAE had a lower risk of major complications (risk ratio [RR], 0.45 [95% CI, 0.22-0.95]

P = 0.04)and a higher risk of minor complications (RR, 1.65 [95% CI, 1.32-2.06]

P < 0.00001)

UAE had a higher risk of re-intervention up to 2 years (RR, 3.74 [95% CI, 1.76-7.96]

P = 0.0006) and up to 5 years (RR, 5.01 [95% CI, 1.37-18.39]

P = 0.02)

UAE had a similar risk of follicle-stimulating hormone levels > 40 IU/L after 6 months (RR, 1.76 [95% CI, 0.24-12.95]

P = 0.58)and of recommending the procedure to another patient up to 5 years after treatment (RR, 1.00 [95% CI, 0.87-1.14]

P = 0.94). The indirect comparison between myomectomy and hysterectomy found that the 2 procedures were similar in the studied outcomes. (C) 2017 Published by Elsevier HS Journals, Inc.
Keywords Hysterectomy
leiomyoma
meta-analysis
uterine artery embolization
uterine myomectomy
xmlui.dri2xhtml.METS-1.0.item-coverage Bridgewater
Language English
Date 2017
Published in Clinical Therapeutics. Bridgewater, v. 39, n. 7, p. 1438-1455, 2017.
ISSN 0149-2918 (Sherpa/Romeo, impact factor)
Publisher Elsevier
Extent 1438-1455
Origin http://dx.doi.org/10.1016/j.clinthera.2017.05.346
Access rights ACESSO RESTRITO
Type Article
Web of Science ID WOS:000407187500015
URI https://repositorio.unifesp.br/handle/11600/53553

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