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Recurrence of Uterine Fibroids After Conservative Surgery or Radiological Procedures: a Narrative Review

  • Fibroid: Review
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Abstract

The present narrative review aims to discuss the available data on the incidence and the risk factors of uterine fibroids (UFs) recurrence after different types of conservative surgical or radiologic procedures in women wishing to preserve their uterus. UFs are the most common benign tumors in women all over the world. Clinical presentation, including abnormal uterine bleeding (AUB), pelvic pain, bulky symptoms, and infertility affect patients’ quality of life, and a large variety of conservative treatments are available especially for those with desire of pregnancy. Fertility sparing surgery, by either laparoscopy, hysteroscopy or laparotomy, or radiological interventions (uterine artery embolization, high-intensity focused ultrasound or magnetic resonance-guided focused ultrasound), are the most common therapeutic approaches. However, the genetic or acquired predisposition to UFs remain despite the treatments, and the recurrences are frequently described in a large percentage of patients. The most relevant risk factors for recurrence of UFs are young age at the first surgery, incomplete fibroid resection, the presence of multiple lesions, an enlarged uterus, and the coexistence with other pelvic diseases. The discussion on the possible medical strategy to reduce the recurrence is an open field of clinical investigation, in particular by using hormonal drugs.

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References

  1. Pavone D, Clemenza S, Sorbi F, Fambrini M, Petraglia F. Epidemiology and risk factors of uterine fibroids. Best Pract Res Clin Obstet Gynaecol. 2018;46:3–11.

    PubMed  Google Scholar 

  2. Stewart EA, Adelman MR, Jacoby VL. ACOG PRACTICE BULLETIN clinical management guidelines for obstetrician-gynecologists NUMBER 228. 2021.

    Google Scholar 

  3. Yang Q, Ciebiera M, Bariani MV, Ali M, Elkafas H, Boyer TG, et al. Comprehensive review of uterine fibroids: developmental origin, pathogenesis, and treatment. Endocr Rev. 2022;43(4):678–719.

    PubMed  Google Scholar 

  4. Soliman AM, Margolis MK, Castelli-Haley J, Fuldeore MJ, Owens CD, Coyne KS. Impact of uterine fibroid symptoms on health-related quality of life of US women: evidence from a cross-sectional survey. Curr Med Res Opin. 2017;33(11):1971–8.

    PubMed  Google Scholar 

  5. Fortin C, Flyckt R, Falcone T. Alternatives to hysterectomy: the burden of fibroids and the quality of life. Best Pract Res Clin Obstet Gynaecol. 2018;46:31–42.

    PubMed  Google Scholar 

  6. Orlandi M, Vannuccini S, el Aoufy K, Melis MR, Lepri G, Sambataro G, et al. Menstruation-related disorders—dysmenorrhea and heavy bleeding—as significant epiphenomena in women with rheumatic diseases. Front Pharmacol. 2022;13:807880. https://doi.org/10.3389/fphar.2022.807880.

  7. Kashani BN, Centini G, Morelli SS, Weiss G, Petraglia F. Role of medical management for uterine leiomyomas. Best Pract Res Clin Obstet Gynaecol. 2016;34:85–103.

    PubMed  Google Scholar 

  8. Stewart EA. Uterine fibroids. The Lancet. 2001;357(9252):293–8.

    CAS  Google Scholar 

  9. Leyland N, Leonardi M, Murji A, Singh SS, 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.

    CAS  PubMed  Google Scholar 

  10. Kramer KJ, Ottum S, Gonullu D, Bell C, Ozbeki H, Berman JM, et al. Reoperation rates for recurrence of fibroids after abdominal myomectomy in women with large uterus. PLoS One. 2021;16(12):e0261085. https://doi.org/10.1371/journal.pone.0261085.

  11. Kim DH, Kim M-L, Song T, Kim MK, Yoon BS, Seong SJ. Is myomectomy in women aged 45 years and older an effective option? Eur J Obstet Gynecol Reprod Biol. 2014;177:57–60.

    PubMed  Google Scholar 

  12. Manyonda I, Belli A-M, Lumsden M-A, Moss J, McKinnon W, Middleton LJ, et al. Uterine-artery embolization or myomectomy for uterine fibroids. New Engl J Med. 2020;383(5):440–51.

    PubMed  Google Scholar 

  13. Liu L, Wang T, Lei B. High-intensity focused ultrasound (HIFU) ablation versus surgical interventions for the treatment of symptomatic uterine fibroids: a meta-analysis. Eur Radiol. 2022;32(2):1195–204.

    PubMed  Google Scholar 

  14. Radosa MP, Owsianowski Z, Mothes A, Weisheit A, Vorwergk J, Asskaryar FA, et al. Long-term risk of fibroid recurrence after laparoscopic myomectomy. Eur J Obstet Gynecol Reprod Biol. 2014;180:35–9.

    CAS  PubMed  Google Scholar 

  15. Yoo E-H, Lee PI, Huh C-Y, Kim D-H, Lee B-S, Lee J-K, et al. Predictors of leiomyoma recurrence after laparoscopic myomectomy. J Minim Invasive Gynecol. 2007;14(6):690–7.

    PubMed  Google Scholar 

  16. Ming X, Zhou J, Gou J, Li N, Nie D, Xue L, et al. A prognostic index model for predicting long-term recurrence of uterine leiomyoma after myomectomy. PLoS One. 2021;16(7):e0254142.

    CAS  PubMed  PubMed Central  Google Scholar 

  17. Hanafi M. Predictors of leiomyoma recurrence after myomectomy. Obstet Gynecol. 2005;105(4):877–81.

    PubMed  Google Scholar 

  18. Cardozo ER, Clark AD, Banks NK, Henne MB, Stegmann BJ, Segars JH. The estimated annual cost of uterine leiomyomata in the United States. Am J Obstet Gynecol. 2012;206(3):211.e1–9.

    PubMed  Google Scholar 

  19. Ming X, Ran XT, Li N, Nie D, Li ZY. Risk of recurrence of uterine leiomyomas following laparoscopic myomectomy compared with open myomectomy. Arch Gynecol Obstet. 2020;301(1):235–42.

    PubMed  Google Scholar 

  20. Zhang J, Go V-A, Blanck JF, Singh B. A systematic review of minimally invasive treatments for uterine fibroid-related bleeding. Reproductive Sciences. 2022;29(10):2786–809.

    PubMed  Google Scholar 

  21. Jin C, Hu Y, Chen X, Zheng F, Lin F, Zhou K, et al. Laparoscopic versus open myomectomy—a meta-analysis of randomized controlled trials. Eur J Obstet Gynecol Reprod Biol. 2009;145(1):14–21.

    PubMed  Google Scholar 

  22. Bhave Chittawar P, Franik S, Pouwer AW, Farquhar C. Minimally invasive surgical techniques versus open myomectomy for uterine fibroids. Cochrane Database Syst Rev. 2014;(10):CD004638. https://doi.org/10.1002/14651858.CD004638.pub3.

  23. Deutsch A, Sasaki KJ, Cholkeri-Singh A. Resectoscopic surgery for polyps and myomas: a review of the literature. J Minim Invasive Gynecol. 2017;24(7):1104–10.

    PubMed  Google Scholar 

  24. Radosa MP, Owsianowski Z, Mothes A, Weisheit A, Vorwergk J, Asskaryar FA, et al. Long-term risk of fibroid recurrence after laparoscopic myomectomy. Eur J Obstet Gynecol Reprod Biol. 2014;180:35–9.

    CAS  PubMed  Google Scholar 

  25. Vilos GA, Allaire C, Laberge P-Y, Leyland N, Vilos AG, Murji A, et al. The management of uterine leiomyomas. J Obstet Gynaecol Canada. 2015;37(2):157–78.

    Google Scholar 

  26. Fauconnier A. Recurrence of leiomyomata after myomectomy. Hum Reprod Update. 2000;6(6):595–602.

    CAS  PubMed  Google Scholar 

  27. Nishiyama S, Saito M, Sato K, Kurishita M, Itasaka T, Shioda K. High recurrence rate of uterine fibroids on transvaginal ultrasound after abdominal myomectomy in japanese women. Gynecol Obstet Invest. 2006;61(3):155–9.

    PubMed  Google Scholar 

  28. Rossetti A, Sizzi O, Soranna L, Cucinelli F, Mancuso S, Lanzone A. Long-term results of laparoscopic myomectomy: recurrence rate in comparison with abdominal myomectomy. Human Reprod. 2001;16(4):770–4.

    CAS  Google Scholar 

  29. Kotani Y, Tobiume T, Fujishima R, Shigeta M, Takaya H, Nakai H, et al. Recurrence of uterine myoma after myomectomy: open myomectomy versus laparoscopic myomectomy. J Obstet Gynaecol Res. 2018;44(2):298–302.

    PubMed  Google Scholar 

  30. Parker WH. Indications for morcellation in gynecologic surgery. Curr Opin Obstet Gynecol. 2018;30(1):75–80.

    PubMed  Google Scholar 

  31. Donnez J, Courtoy GE, Dolmans M-M. Fibroid management in premenopausal women. Climacteric. 2019;22(1):27–33.

    CAS  PubMed  Google Scholar 

  32. Obed JY, Bako B, Usman JD, Moruppa JY, Kadas S. Uterine fibroids: risk of recurrence after myomectomy in a Nigerian population. Arch Gynecol Obstet. 2011;283(2):311–5.

    PubMed  Google Scholar 

  33. Emanuel M. Long-term results of hysteroscopic myomectomy for abnormal uterine bleeding. Obstet Gynecol. 1999;93(5):743–8.

    CAS  PubMed  Google Scholar 

  34. Batra N, Khunda A, O’Donovan PJ. Hysteroscopic myomectomy. Obstet Gynecol Clin North Am. 2004;31(3):669–85.

    PubMed  Google Scholar 

  35. Wamsteker K, Emanuel MH, de Kruif JH. Transcervical hysteroscopic resection of submucous fibroids for abnormal uterine bleeding: results regarding the degree of intramural extension. Obstet Gynecol. 1993;82(5):736–40.

    CAS  PubMed  Google Scholar 

  36. di Spiezio SA, Giampaolino P, Manzi A, de Angelis MC, Zizolfi B, Alonso L, et al. The Invisible External Cervical Os. Tips and tricks to overcome this challenge during in-office hysteroscopy. J Minim Invasive Gynecol. 2021;28(2):172–3.

    Google Scholar 

  37. Capmas P, Pourcelot A-G, Giral E, Fedida D, Fernandez H. Office hysteroscopy: a report of 2402 cases. J Gynecol Obstet Biol Reprod (Paris). 2016;45(5):445–50.

    CAS  PubMed  Google Scholar 

  38. Vitagliano A, Noventa M, di Spiezio SA, Saccone G, Gizzo S, Borgato S, et al. Uterine fibroid size modifications during pregnancy and puerperium: evidence from the first systematic review of literature. Arch Gynecol Obstet. 2018;297(4):823–35.

    PubMed  Google Scholar 

  39. Kim A, Arabkhazaeli M, Ulrich A, Lerner V, Shin JH. Updates in uterine artery embolization for leiomyomas. Curr Opin Obstet Gynecol. 2020;32(4):269–76.

    PubMed  Google Scholar 

  40. Wu F, Wang Z-B, Chen W-Z, Zou J-Z, Bai J, Zhu H, et al. Extracorporeal focused ultrasound surgery for treatment of human solid carcinomas: early Chinese clinical experience. Ultrasound Med Biol. 2004;30(2):245–60.

    PubMed  Google Scholar 

  41. Manyonda I, Belli A-M, Lumsden M-A, Moss J, McKinnon W, Middleton LJ, et al. Uterine-artery embolization or myomectomy for uterine fibroids. New Engl J Med. 2020;383(5):440–51.

    PubMed  Google Scholar 

  42. Moss J, Cooper K, Khaund A, Murray L, Murray G, Wu O, et al. Randomised comparison of uterine artery embolisation (UAE) with surgical treatment in patients with symptomatic uterine fibroids (REST trial): 5-year results. BJOG. 2011;118(8):936–44.

    CAS  PubMed  Google Scholar 

  43. de Bruijn AM, Ankum WM, Reekers JA, Birnie E, van der Kooij SM, Volkers NA, et al. Uterine artery embolization vs hysterectomy in the treatment of symptomatic uterine fibroids: 10-year outcomes from the randomized EMMY trial. Am J Obstet Gynecol. 2016;215(6):745.e1–745.e12.

    PubMed  Google Scholar 

  44. Gupta JK, Sinha A, Lumsden MA, Hickey M. Uterine artery embolization for symptomatic uterine fibroids. Cochrane Database Syst Rev. 2014;(12):CD005073. https://doi.org/10.1002/14651858.CD005073.pub4.

  45. Amoah A, Quinn SD. Uterine-preserving treatments or hysterectomy reintervention after myomectomy or uterine artery embolisation: a retrospective cohort study of long-term outcomes. BJOG. 2023;130(7):823–31.

    CAS  PubMed  Google Scholar 

  46. Sandberg EM, Tummers FHMP, Cohen SL, van den Haak L, Dekkers OM, Jansen FW. Reintervention risk and quality of life outcomes after uterine-sparing interventions for fibroids: a systematic review and meta-analysis. Fertil Steril. 2018;109(4):698–707.e1.

    PubMed  Google Scholar 

  47. Yuan B, Qin X, Xi J. The comparison of life quality between ultrasound-guided high-intensity focused ultrasound and laparoscopic myomectomy for the treatment of uterine fibroids. Comput Math Methods Med. 2022;2022:1–5.

    CAS  Google Scholar 

  48. Liu L, Wang T, Lei B. High-intensity focused ultrasound (HIFU) ablation versus surgical interventions for the treatment of symptomatic uterine fibroids: a meta-analysis. Eur Radiol. 2022;32(2):1195–204.

    PubMed  Google Scholar 

  49. Laughlin-Tommaso S, Barnard EP, AbdElmagied AM, Vaughan LE, Weaver AL, Hesley GK, et al. FIRSTT study: randomized controlled trial of uterine artery embolization vs focused ultrasound surgery. Am J Obstet Gynecol. 2019;220(2):174.e1–174.e13.

    PubMed  Google Scholar 

  50. Lethaby A, Puscasiu L, Vollenhoven B. Preoperative medical therapy before surgery for uterine fibroids. Cochrane Database Syst Rev. 2017;2017(11):CD000547. https://doi.org/10.1002/14651858.CD000547.pub2.

  51. Wei J, Ma X, Wang W, Zhang M, Yu Z, Zhang W, et al. Gonadotropin-releasing hormone agonist versus expectant management for treating multiple leiomyomas after myomectomy: the study protocol for a multicentre, prospective, randomised controlled clinical trial. BMJ Open. 2021;11(10):e044347. https://doi.org/10.1136/bmjopen-2020-044347.

  52. Carr BR, Stewart EA, Archer DF, Al-Hendy A, Bradley L, Watts NB, et al. Elagolix alone or with add-back therapy in women with heavy menstrual bleeding and uterine leiomyomas a randomized controlled trial. Obstet Gynecol. 2018;132:1252–64.

    CAS  PubMed  PubMed Central  Google Scholar 

  53. Al-Hendy A, Lukes AS, Poindexter AN, Venturella R, Villarroel C, Critchley HOD, et al. Treatment of uterine fibroid symptoms with relugolix combination therapy. New Engl J Med. 2021;384(7):630–42.

    CAS  PubMed  Google Scholar 

  54. Donnez J, Taylor HS, Stewart EA, Bradley L, Marsh E, Archer D, et al. Linzagolix with and without hormonal add-back therapy for the treatment of symptomatic uterine fibroids: two randomised, placebo-controlled, phase 3 trials. The Lancet. 2022;400(10356):896–907.

    CAS  Google Scholar 

  55. European Medicines Agency. Ulipristal acetate 5mg medicinal products - referral. 2020. https://www.ema.europa.eu/en/medicines/human/referrals/ulipristal-acetate-5mg-medicinal-products. Retrieved October 20, 2020.

  56. Sabry M, Halder SK, Ait Allah ASA, Roshdy E, Rajaratnam V, Al-Hendy A. Serum vitamin D3 level inversely correlates with uterine fibroid volume in different ethnic groups: a cross-sectional observational study. Int J Womens Health. 2013;5(1):93–100.

    CAS  PubMed  PubMed Central  Google Scholar 

  57. Paffoni A, Somigliana E, Vigano’ P, Benaglia L, Cardellicchio L, Pagliardini L, et al. Vitamin D status in women with uterine leiomyomas. J Clin Endocrinol Metab. 2013;98(8):E1374-8. https://doi.org/10.1210/jc.2013-1777.

  58. Vahdat M, Allahqoli L, Mirzaei H, Giovannucci E, Salehiniya H, Mansouri G, et al. The effect of vitamin D on recurrence of uterine fibroids: a randomized, double-blind, placebo-controlled pilot study. Complement Ther Clin Pract. 2022;46:101536. https://doi.org/10.1016/j.ctcp.2022.101536.

  59. Tian Y, Long T, Dai Y. Pregnancy outcomes following different surgical approaches of myomectomy. J Obstet Gynaecol Res. 2015;41(3):350–7.

    PubMed  Google Scholar 

  60. Şükür YE, Kankaya D, Ateş C, Sertçelik A, Cengiz SD, Aytaç R. Clinical and histopathologic predictors of reoperation due to recurrence of leiomyoma after laparotomic myomectomy. Int J Gynecol Obstet. 2015;129(1):75–8.

    Google Scholar 

  61. Capezzuoli T, Vannuccini S, Fantappiè G, Orlandi G, Rizzello F, Coccia ME, et al. Ultrasound findings in infertile women with endometriosis: evidence of concomitant uterine disorders. Gynecol Endocrinol. 2020;36(9):808–12.

    PubMed  Google Scholar 

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  1. Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Viale Morgagni 44, 50134, Florence, Italy

    Tommaso Capezzuoli, Silvia Vannuccini, Gretha Orlandi, Francesco La Torre, Flavia Sorbi, Massimiliano Fambrini & Felice Petraglia

  2. Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey

    Batuhan Aslan

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Contributions

FP, TC, and BA designed the study. TC and BA collected the literature. SV, BA, and FLT revised the available studies. TC wrote the first draft. FP, TC, BA, SV, GO, FLT, FA, and MF critically discussed and revised the content of the manuscript and had final approval of the manuscript in its present form.

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Correspondence to Felice Petraglia.

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Capezzuoli, T., Aslan, B., Vannuccini, S. et al. Recurrence of Uterine Fibroids After Conservative Surgery or Radiological Procedures: a Narrative Review. Reprod. Sci. 31, 1171–1178 (2024). https://doi.org/10.1007/s43032-023-01418-2

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