Surgical Intervention for Uterine Fibroids. Our 4-Year Experience and Literature Review: Is It Time to Centralise Care Provision Via Specialist Fibroid Centres?

BACKGROUND: Leiomyomas are common in women of reproductive age, for whom treatment-stratification can be challenging. We assessed factors influencing pre-operative selection of surgical intervention and compare outcomes. PATIENTS AND METHODS: A literature review was performed and surgical interventions for fibroids at a London hospital (2015-2018) were retrospectively examined. Outcomes assessed were estimated blood loss, length of stay (LOS) and complications. Data were analysed using univariate non-parametric inferential statistics. RESULTS: A total of 258 cases were identified. Estimated blood loss was statistically significantly lower for laparoscopic versus open myomectomy [200 (interquartile range; IQR)=100-200 vs. 400 (IQR=200-700 ml), p<0.001]. Length of stay was also statistically significantly lower in the laparoscopic cohort compared with open hysterectomy [1 (IQR=1-1) days vs. 2 (IQR=2-3 days)]. Similar results were noted when comparing laparoscopic versus open hysterectomy [167 (IQR=100-200) vs. 500 (IQR=100-750) ml, p<0.001]. No differences in complications were reported across groups. Patients counselled by a surgeon trained in minimally invasive surgery (MIS) opted more frequently for laparoscopy (p<0.01, rho=-0.669). Estimated blood loss during MIS was 225 ml versus 545 ml for non-MIS, and 285 ml for the overall cohort (p<0.01).The length of stay was statistically significantly lower for those treated with MIS (1.37 days) versus other surgeons (2.65 days), or overall cohort (1.63 days) (p<0.01 for all associations). CONCLUSION: Laparoscopic surgery offers superior short-term outcomes when performed by experienced operators. Multidisciplinary counselling and treatment stratification should be gold-standard practice. Centralisation of care provision in fibroid Centres of Excellence is required.