Combo treatment best for fibroids

By Martha Kerr

NEW YORK (Reuters Health) - A minimally invasive treatment strategy that combines blocking blood vessels with surgical removal appears to be the best method of addressing fibroid tumors that reappear following prior treatment, Taiwanese investigators report.

Furthermore, the combined approach does not appear to jeopardize fertility any more than surgical removal alone, Dr. Wei-Min Lui and associates report in the journal Fertility and Sterility.

Fibroids are common, non-cancerous growths on the walls of the uterus. These tumors can cause pain, menstrual irregularities, and other problems, but in many women they produce no symptoms. Treatments include removal of the tumor itself, removal of the uterus, and shrinking the tumor by cutting off its blood supply (uterine artery occlusion).

Lui, of Taipei Medical University, and colleagues studied a group of 82 women with fibroids that returned after prior surgical removal. All study subjects had undergone surgery 7 months to 10 years before the study, and they expressed a "strong desire" to keep their uterus, which would preserve their ability to become pregnant.

Fifty-two underwent artery blockage plus surgical removal using laparoscopic, or "keyhole" techniques, as opposed to more invasive conventional abdominal surgery. The remaining 30 women underwent surgical laparoscopic removal alone.

After an average of 43 months of follow-up, the fibroid recurrence rate was 5.8 percent with the combined approach compared with 36.7 percent laparoscopic removal alone.

Blood loss was also greatly reduced with the laparoscopic approach, the report indicates.

The pregnancy rate after treatment was not significantly different between the two groups, at 19.2 percent with the combined treatment and 22.4 percent with laparoscopic removal alone.

SOURCE: Fertility and Sterility, February 2007.