Original Articles
Recurrence of Leiomyomata after Laparoscopic Myomectomy

https://doi.org/10.1016/S1074-3804(05)60610-XGet rights and content

Abstract

Study Objective

To assess recurrence of leiomyomata after laparoscopic myomectomy (LM) and evaluate predictive factors of recurrence.

Design

Observational study (Canadian Task Force classification II-2).

Setting

University hospital

Patients

One hundred ninety-six women.

Intervention

Laparoscopic myomectomy with mean follow-up of 47 months.

Measurements and Main Results

Myoma recurrence included recurrence of initial symptomatology before LM, recurrence at clinical examination, and appearance of a myoma 2 cm or larger on ultrasound examination. Recurrence was observed in 45 patients (22.9%). The mean time before recurrence was 42 months (range 4–95 mo). Eight women (4.08%) required reoperation. The cumulative recurrence risk was 12.7% at 2 years and 16.7% at 5 years. Predictive factors for recurrence were number of myomas and nulliparity.

Conclusion

According to our results, the cumulative rate of myoma recurrence within 5 years appears greater after LM than after laparotomy. However, this should not lead us to reject laparoscopy, which has many advantages compared with laparotomy, in particular its low morbidity.

Section snippets

Materials and Methods

Between March 1989 and December 1996, 196 women (mean age 36.6 ± 6.6 yrs, range 18–54 yrs; Table 1) underwent LM. The technique is described elsewhere (mean operating time 126 ± 63 min, range 20–320 min; mean hospital stay 2.5 ± 0.8 days).1, 2, 3, 4, 5, 6, 7 Indications for LM were functional signs such as menometrorrhagia (22.9%) and pain (26.1%), discovery of a myoma during infertility investigations (31.6%), enlarged uterus with myomas (16.8%), pelvic compression (1.6%), and history of

Results

Twenty-three patients (11.7%) were lost to follow-up. The other 173 women were seen regularly. The mean duration of follow-up was 47.4 ± 23.2 months (range 4.3–97.8 mo) and rate of recurrence was 22.9% (45 patients). The mean length of time before recurrence was 42 ± 22 months (range 4–95 mo). Of the 173 women, 8 (4.6%) were reoperated for reasons connected with myoma recurrence. For these women, the second operative procedures were LM (3), myomectomy by laparotomy (1), and hysterectomy by

Discussion

The frequency of recurrence after LM in our series was satisfactory (45 patients, 22.9%). To our knowledge, only two other studies specifically addressed the rate of recurrence after LM.13, 14 In one study the rate was 46%.13 However, that rate was global and included not only cases of LM but cases of laparotomy. Another group reported 33.3% recurrence,14 more than our study.

Analysis in terms of cumulative rates appears to show a greater frequency of recurrence after operative laparoscopy than

Conclusion

It is difficult to evaluate the risk of recurrence after myomectomy, whether the approach is laparoscopy or laparotomy. Although the cumulated risk at 5 years appears to be greater after LM, this is probably due to the fact that palpation and assessment of small residual myomas is far more difficult by laparoscopy than by laparotomy; these results must not lead us to reject LM, however. The results of LM in terms of recurrence will be good as long as indications are clearly defined. Thus this

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    Copyright © 2001 The American Association of Gynecologic Laparoscopists. Published by Elsevier Inc. All rights reserved.