Long-term Outcome of MR-Guided Focused Ultrasound Treatment and Laparoscopic Myomectomy for Symptomatic Uterine Fibroid Tumors

Fibroid tumors occur in up to 25% of reproductive-age women and are the most common benign tumors in this age group. The majority of fibroid tumors are asymptomatic and are discovered incidentally during clinical examination or imaging. However, approximately 20% to 50% of women with fibroid tumors have clinical symptoms. Treatment is usually indicated for symptomatic women; different techniques have been used. Hysterectomy is a definitive treatment for uterine fibroid tumors. For women who seek uterine preservation, the tumors can be removed surgically by either open myomectomy, laparoscopy, or hysteroscopy. Currently, many surgeons consider laparoscopic myomectomy as the best management option for symptomatic uterine fibroid tumors in women wishing to maintain their fertility. Although it is an effective and safe technique, with an extremely low failure rate and recurrence rate when performed by an experienced surgeon, fibroid morcellation during the laparoscopic procedure can result in the very rare occurrence of undiagnosed malignant fibroid tumors. A more conservative and noninvasive treatment is magnetic resonance-guided focused ultrasound (MRgFUS). This nonsurgical technique uses high-intensity ultrasound waves that lead to tumor cell death and clinical relief of symptoms. A study published in 2012 showed that 69% of women who were treated by MRgFUS with a follow-up of 33 months did not need any additional alternative treatment, and only 24% underwent subsequent surgical interventions. To date, long-term results of up to 5 years of observation comparing laparoscopic myomectomy with MRgFUS have not been published. The aim of this follow-up cohort study was to provide long-term comparison of the clinical outcome in women with symptomatic uterine fibroid tumors treated either by MRgFUS or laparoscopic myomectomy. Participants were patients with symptomatic uterine fibroid tumors who had been admitted to a single tertiary care center from January 2012 to January 2017. The Uterine Fibroid Symptom and Quality of Life symptom severity score was used to assess for further interventions and sustained fibroid-associated symptoms. A total of 154 women met the inclusion criteria; of these, 84 underwent laparoscopic or robotic-assisted laparoscopic myomectomy, and 70 were treated with MRgFUS. Complete follow-up was achieved for 64 of the women who underwent laparoscopic myomectomy and for 68 of those treated by MRgFUS. In both groups, follow-up time was similar (median, 31 months [interquartile range, 17-51 months] and 36 months [interquartile range, 24-41 months]; P = 0.95). Additional interventions were required in 5 (7.8%) and 9 women (13.2%), respectively (P = 0.312). At follow-up interviews, the Uterine Fibroid Symptom and Quality of Life symptom severity score questionnaire score had comparable median scores of 17 (interquartile range, 12-21) and 17 (interquartile range, 13-22) for laparoscopic myomectomy and MRgFUS, respectively (P = 0.439). These findings were not changed by separate analysis of each symptom (bleeding, changes in menstruation, abdominal pain, bladder activity, nocturia, fatigue) or multivariate analysis. These findings show that satisfaction with long-term outcomes and the rate of reintervention were comparable after MRgFUS treatment or laparoscopic myomectomy for uterine fibroid tumors. The data are important for clinicians who provide consultation for women seeking medical advice. Based on the similarity of the good clinical long-term results, both treatments should be presented as possibilities to the appropriate patients. Larger randomized prospective trials are needed using comparable populations to confirm these findings.