MR imaging evaluation of fibroid clearance following open myomectomy for massive/multiple symptomatic fibroids

• Published in: Archives of gynecology and obstetrics Vol. 286; no. 5; pp. 1165 - 1171
• Main Authors: Wijesekera, Nevin T., Mauri, Giovanni, Gupta, Sahana, Belli, Anna-Maria, Manyonda, Isaac T.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.11.2012; Springer Nature B.V
• Subjects: Abdominal Pain - etiology; Abdominal Pain - surgery; Adult; Blood Loss, Surgical; Blood Volume; Chi-Square Distribution; Endocrinology; Female; Fibroids; Follow-Up Studies; General Gynecology; Gynecology; Human Genetics; Humans; Leiomyomatosis - complications; Leiomyomatosis - pathology; Leiomyomatosis - surgery; Magnetic Resonance Imaging; Medicine; Medicine & Public Health; Menorrhagia - etiology; Menorrhagia - surgery; Middle Aged; Neoplasm, Residual; Obstetrics/Perinatology/Midwifery; Organ Size; Seroma - diagnosis; Seroma - etiology; Treatment Outcome; Tumor Burden; Uterine Myomectomy - adverse effects; Uterine Neoplasms - complications; Uterine Neoplasms - pathology; Uterine Neoplasms - surgery; Uterus - pathology; Open myomectomy; MRI; Massive/multiple fibroids
• ISSN: 0932-0067; 1432-0711
• DOI: 10.1007/s00404-012-2404-5

Purpose To evaluate the technical success of total fibroid clearance at open myomectomy for massive and/or multiple symptomatic fibroids using MR imaging (MRI) as the imaging modality. Methods The study group comprised 27 women [mean age 37.4 ± 6.9 years (range 27–53)] who underwent open myomectomy for the treatment of massive/multiple symptomatic fibroids at our institution between January 2009 and April 2010. Myomectomy was performed with the intention of achieving complete fibroid clearance. Pre- and postmyomectomy MRI was performed to assess changes in uterine volume and fibroid burden. Periprocedural data (including blood loss and complications) and relief of clinical symptoms at follow-up were also recorded. Results The mean time to MRI and clinical follow-up was 10 months (range 6–15 months). The mean uterine volume premyomectomy was 795 ± 580 cc and postmyomectomy was 123 ± 70 cc ( p  < 0.001). The mean percentage reduction in uterine volume was 80.3 % (range 43.0–98.1 %). Of the 10/27 (37.0 %) women with residual fibroids at follow-up: 7 patients had fibroids measuring up to 1 cc in volume, 3 patients had fibroids measuring up to 6 cc. Postoperative adnexal seromas were observed in 6/27 (22.2 %) patients. The clinical success rates of myomectomy amongst the 22/27 (81 %) responders were: 73 % for menorrhagia, 64 % for pain, and 36–64 % for mass-related symptoms. Conclusions Using MRI, we have confirmed that open myomectomy can achieve total or near-total fibroid clearance in the majority of patients with massive and/or multiple fibroids.