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Despite the extensive data on uterine artery embolization (UAE) procedures (Journal Watch Women’s Health Aug 23 2005), randomized trials comparing UAE and hysterectomy have been limited by small numbers and brief follow-ups. In this U.K. trial, patients (mean age, 43 years) with symptomatic uterine fibroids were randomized either to UAE (95 evaluable patients) or to abdominal hysterectomy or myomectomy, depending on whether they wanted to retain their uteri (45 evaluable patients).
At 1 month and 12 months after the procedure, survey scores for quality of life, symptoms, and resumption of usual activities were similar in the two groups. Median hospital stay was significantly shorter in the UAE group than in the surgery group. Likewise, return to work and to other activities was significantly earlier after UAE. Although the incidence of major adverse events was similar in both treatment arms, 8 of 10 events in the surgery group occurred during initial hospitalization, whereas 15 of 16 events in the UAE group occurred after discharge. Twenty percent of women in the UAE group required an additional invasive procedure for continued or recurrent symptoms.
The REST Investigators. Uterine-artery embolization versus surgery for symptomatic uterine fibroids. N Engl J Med 2007 Jan 25; 356:360-70.
Comment
Uterine fibroids are the most common indication for hysterectomy in U.S. women; thus, less-invasive treatments are welcome. Because uncertainties remain as to whether UAE is appropriate for women who might want to conceive, it is surprising that this trial included women who wished to retain their fertility. In addition, if some hysterectomies had been performed as laparoscopically assisted vaginal procedures, return to work probably would have been sooner. We await longer-term results from this ongoing study; nonetheless, we now have sufficient experience with UAE to discuss it routinely with women who have symptomatic fibroids and who are facing surgery. These results will help us counsel our patients about the pros and cons of hysterectomy (definitive treatment, slower recovery) and UAE (quicker recovery, risk for additional treatment).