Conservative Treatment Of Uterine Myomas: A Network Meta-analysis Of Randomized Controlled Studies.: NMA For Uterine Myomas Conservative Treatment

Objective: To comparatively evaluate the effectiveness of uterine artery embolization (UAE), focused ultrasound (HIFU), radiofrequency ablation (RFT), and laparoscopic/laparotomic surgery in the conservative treatment of uterine fibroids DATA SOURCES: The research was performed via electronic databases PubMed, EMBASE, and Cochrane Library, using the PRISMA standards.

Methods of study selection: The network included 10 randomized trials between 2000 and 2024 and 1002 randomized subjects.

Tabulation: The Network meta-analysis (NMA) was carried out with subroutine netmeta on R. The risk of bias was assessed using the Revised Cochrane risk-of-bias tool for randomized trials. The surface under the cumulative ranking curve (SUCRA) was computed by Bayesian NMA.

Integrations and results: Integrations and Results: Incidences of reintervention per 100 person/year of follow-up were 4.13 (range 0 to 19.4), 16.1 (6.2 to 32.8), 14.3 (0 to 15.1) and 6 (4.3 to 6.7) for myomectomy, UAE, HIFU and RFT, respectively. The incidence rate ratios compared to myomectomy were 2.45 (95% CI = 1.38-4.37), 5.23 (95% CI = 1.59,17.3), and 4.59 (95% CI= 0.77-27.3, p=0.09) for UAE, HIFU and RFT, respectively. RTF had the highest (SUCRA=1.25% and 3%) while myomectomy had the lowest (SUCRA=98% and 95%) risk of reintervention or hysterectomy during follow-up (median 12 months, range 3-24). The risk of major complications was significantly lower after UAE (OR=0.38,95%CI=0.17-0.85) than myomectomy. The procedure with the lowest likelihood of major complications was HIFU (SUCRA=81.5%). Finally, in the evaluation of QoL at follow-up visits 60 there were no differences between the treatments studied, although the model was highly heterogeneous and inconsistent.

Conclusion: In analysis of randomized trials, surgical myomectomy carried the least risk of reintervention and subsequent hysterectomy during a relatively short follow up period. HIFU was the method with the lowest risk of major complications.