Predictors of leiomyoma recurrence after laparoscopic myomectomy

Eun Hee Yoo, Paul I. Lee, Chu Yeop Huh, Dong Ho Kim, Byung Seok Lee, Jae Kwan Lee, Donguk Kim

Research output: Contribution to journalArticle

72 Citations (Scopus)

Abstract

Study objective: To evaluate recurrence and reoperation rate after laparoscopic myomectomy in relation to risk factors and identify suitable candidates for laparoscopic myomectomy to decrease recurrence. Design: Multicenter retrospective cohort study (Canadian Task Force classification II-2). Setting: Five university hospitals and a university-affiliated teaching hospital. Patients: Five hundred and twelve women who underwent laparoscopic myomectomy between 1995 and 2004. All patients had a follow-up with clinical examination and transvaginal sonography for a median 13 months after surgery. Intervention: Laparoscopic myomectomy. Measurements and main results: Recurrence was defined as the appearance of a leiomyoma on ultrasound examination or identification of leiomyoma during subsequent surgery after the initial surgery. Cox regression (full model) analysis of the possible risk factors for recurrence followed by a stepwise variable selection was performed to eliminate confounding factors. The cumulative probability of leiomyoma recurrence increased steadily during the follow-up period, 11.7% after 1 year, 36.1% after 3 years, 52.9% at 5 years, and reached 84.4% at 8 years. The cumulative probability of reoperation for recurrent leiomyoma was much lower: 6.7% at 5 years and 16% at 8 years. Significant risk factors that were independently associated with cumulative recurrence were age, preoperative number of myoma, preoperative uterine size by pelvic examination, presence of associated pelvic disease, and delivery after laparoscopic myomectomy. The operative time and change of hematocrit were associated with the reoperation. Those who had fewer than 2 myomas before surgery, uterus size less than 13 gestational weeks measured by pelvic examination, no childbirth after laparoscopic myomectomy, and age at index surgery less than 35.5 years showed the lowest recurrence after laparoscopic myomectomy from Classification and Regression trees analysis. Conclusion: The risk of recurrence of leiomyoma after laparoscopic myomectomy is linked with the age, preoperative number of leiomyoma, preoperative uterine size, presence of associated pelvic disease, and childbirth after surgery.

Original languageEnglish
Pages (from-to)690-697
Number of pages8
JournalJournal of Minimally Invasive Gynecology
Volume14
Issue number6
DOIs
Publication statusPublished - 2007 Nov 1

Fingerprint

Uterine Myomectomy
Leiomyoma
Recurrence
Reoperation
Myoma
Gynecological Examination
Parturition
Advisory Committees
Operative Time
Hematocrit
Teaching Hospitals
Uterus
Ultrasonography
Cohort Studies
Retrospective Studies
Regression Analysis

Keywords

  • Cumulative recurrence rate
  • Cumulative reoperation rate
  • Laparoscopic myomectomy
  • Prognostic factors
  • Recurrence

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

Cite this

Predictors of leiomyoma recurrence after laparoscopic myomectomy. / Yoo, Eun Hee; Lee, Paul I.; Huh, Chu Yeop; Kim, Dong Ho; Lee, Byung Seok; Lee, Jae Kwan; Kim, Donguk.

In: Journal of Minimally Invasive Gynecology, Vol. 14, No. 6, 01.11.2007, p. 690-697.

Research output: Contribution to journalArticle

Yoo, Eun Hee ; Lee, Paul I. ; Huh, Chu Yeop ; Kim, Dong Ho ; Lee, Byung Seok ; Lee, Jae Kwan ; Kim, Donguk. / Predictors of leiomyoma recurrence after laparoscopic myomectomy. In: Journal of Minimally Invasive Gynecology. 2007 ; Vol. 14, No. 6. pp. 690-697.
@article{55bd3fbca029431782449403d8d51fce,
title = "Predictors of leiomyoma recurrence after laparoscopic myomectomy",
abstract = "Study objective: To evaluate recurrence and reoperation rate after laparoscopic myomectomy in relation to risk factors and identify suitable candidates for laparoscopic myomectomy to decrease recurrence. Design: Multicenter retrospective cohort study (Canadian Task Force classification II-2). Setting: Five university hospitals and a university-affiliated teaching hospital. Patients: Five hundred and twelve women who underwent laparoscopic myomectomy between 1995 and 2004. All patients had a follow-up with clinical examination and transvaginal sonography for a median 13 months after surgery. Intervention: Laparoscopic myomectomy. Measurements and main results: Recurrence was defined as the appearance of a leiomyoma on ultrasound examination or identification of leiomyoma during subsequent surgery after the initial surgery. Cox regression (full model) analysis of the possible risk factors for recurrence followed by a stepwise variable selection was performed to eliminate confounding factors. The cumulative probability of leiomyoma recurrence increased steadily during the follow-up period, 11.7{\%} after 1 year, 36.1{\%} after 3 years, 52.9{\%} at 5 years, and reached 84.4{\%} at 8 years. The cumulative probability of reoperation for recurrent leiomyoma was much lower: 6.7{\%} at 5 years and 16{\%} at 8 years. Significant risk factors that were independently associated with cumulative recurrence were age, preoperative number of myoma, preoperative uterine size by pelvic examination, presence of associated pelvic disease, and delivery after laparoscopic myomectomy. The operative time and change of hematocrit were associated with the reoperation. Those who had fewer than 2 myomas before surgery, uterus size less than 13 gestational weeks measured by pelvic examination, no childbirth after laparoscopic myomectomy, and age at index surgery less than 35.5 years showed the lowest recurrence after laparoscopic myomectomy from Classification and Regression trees analysis. Conclusion: The risk of recurrence of leiomyoma after laparoscopic myomectomy is linked with the age, preoperative number of leiomyoma, preoperative uterine size, presence of associated pelvic disease, and childbirth after surgery.",
keywords = "Cumulative recurrence rate, Cumulative reoperation rate, Laparoscopic myomectomy, Prognostic factors, Recurrence",
author = "Yoo, {Eun Hee} and Lee, {Paul I.} and Huh, {Chu Yeop} and Kim, {Dong Ho} and Lee, {Byung Seok} and Lee, {Jae Kwan} and Donguk Kim",
year = "2007",
month = "11",
day = "1",
doi = "10.1016/j.jmig.2007.06.003",
language = "English",
volume = "14",
pages = "690--697",
journal = "Journal of Minimally Invasive Gynecology",
issn = "1553-4650",
publisher = "Elsevier",
number = "6",

}

TY - JOUR

T1 - Predictors of leiomyoma recurrence after laparoscopic myomectomy

AU - Yoo, Eun Hee

AU - Lee, Paul I.

AU - Huh, Chu Yeop

AU - Kim, Dong Ho

AU - Lee, Byung Seok

AU - Lee, Jae Kwan

AU - Kim, Donguk

PY - 2007/11/1

Y1 - 2007/11/1

N2 - Study objective: To evaluate recurrence and reoperation rate after laparoscopic myomectomy in relation to risk factors and identify suitable candidates for laparoscopic myomectomy to decrease recurrence. Design: Multicenter retrospective cohort study (Canadian Task Force classification II-2). Setting: Five university hospitals and a university-affiliated teaching hospital. Patients: Five hundred and twelve women who underwent laparoscopic myomectomy between 1995 and 2004. All patients had a follow-up with clinical examination and transvaginal sonography for a median 13 months after surgery. Intervention: Laparoscopic myomectomy. Measurements and main results: Recurrence was defined as the appearance of a leiomyoma on ultrasound examination or identification of leiomyoma during subsequent surgery after the initial surgery. Cox regression (full model) analysis of the possible risk factors for recurrence followed by a stepwise variable selection was performed to eliminate confounding factors. The cumulative probability of leiomyoma recurrence increased steadily during the follow-up period, 11.7% after 1 year, 36.1% after 3 years, 52.9% at 5 years, and reached 84.4% at 8 years. The cumulative probability of reoperation for recurrent leiomyoma was much lower: 6.7% at 5 years and 16% at 8 years. Significant risk factors that were independently associated with cumulative recurrence were age, preoperative number of myoma, preoperative uterine size by pelvic examination, presence of associated pelvic disease, and delivery after laparoscopic myomectomy. The operative time and change of hematocrit were associated with the reoperation. Those who had fewer than 2 myomas before surgery, uterus size less than 13 gestational weeks measured by pelvic examination, no childbirth after laparoscopic myomectomy, and age at index surgery less than 35.5 years showed the lowest recurrence after laparoscopic myomectomy from Classification and Regression trees analysis. Conclusion: The risk of recurrence of leiomyoma after laparoscopic myomectomy is linked with the age, preoperative number of leiomyoma, preoperative uterine size, presence of associated pelvic disease, and childbirth after surgery.

AB - Study objective: To evaluate recurrence and reoperation rate after laparoscopic myomectomy in relation to risk factors and identify suitable candidates for laparoscopic myomectomy to decrease recurrence. Design: Multicenter retrospective cohort study (Canadian Task Force classification II-2). Setting: Five university hospitals and a university-affiliated teaching hospital. Patients: Five hundred and twelve women who underwent laparoscopic myomectomy between 1995 and 2004. All patients had a follow-up with clinical examination and transvaginal sonography for a median 13 months after surgery. Intervention: Laparoscopic myomectomy. Measurements and main results: Recurrence was defined as the appearance of a leiomyoma on ultrasound examination or identification of leiomyoma during subsequent surgery after the initial surgery. Cox regression (full model) analysis of the possible risk factors for recurrence followed by a stepwise variable selection was performed to eliminate confounding factors. The cumulative probability of leiomyoma recurrence increased steadily during the follow-up period, 11.7% after 1 year, 36.1% after 3 years, 52.9% at 5 years, and reached 84.4% at 8 years. The cumulative probability of reoperation for recurrent leiomyoma was much lower: 6.7% at 5 years and 16% at 8 years. Significant risk factors that were independently associated with cumulative recurrence were age, preoperative number of myoma, preoperative uterine size by pelvic examination, presence of associated pelvic disease, and delivery after laparoscopic myomectomy. The operative time and change of hematocrit were associated with the reoperation. Those who had fewer than 2 myomas before surgery, uterus size less than 13 gestational weeks measured by pelvic examination, no childbirth after laparoscopic myomectomy, and age at index surgery less than 35.5 years showed the lowest recurrence after laparoscopic myomectomy from Classification and Regression trees analysis. Conclusion: The risk of recurrence of leiomyoma after laparoscopic myomectomy is linked with the age, preoperative number of leiomyoma, preoperative uterine size, presence of associated pelvic disease, and childbirth after surgery.

KW - Cumulative recurrence rate

KW - Cumulative reoperation rate

KW - Laparoscopic myomectomy

KW - Prognostic factors

KW - Recurrence

UR - http://www.scopus.com/inward/record.url?scp=35548977497&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=35548977497&partnerID=8YFLogxK

U2 - 10.1016/j.jmig.2007.06.003

DO - 10.1016/j.jmig.2007.06.003

M3 - Article

C2 - 17980328

AN - SCOPUS:35548977497

VL - 14

SP - 690

EP - 697

JO - Journal of Minimally Invasive Gynecology

JF - Journal of Minimally Invasive Gynecology

SN - 1553-4650

IS - 6

ER -