Predictors of leiomyoma recurrence after laparoscopic myomectomy.
OBJECTIVE
To evaluate recurrence and reoperation rate after laparoscopic myomectomy in relation to risk factors and identify suitable candidates for laparoscopic myomectomy to decrease recurrence.


METHODS
Multicenter retrospective cohort study (Canadian Task Force classification II-2).


METHODS
Five university hospitals and a university-affiliated teaching hospital.


METHODS
Five hundred and twelve women who underwent laparoscopic myomectomy between 1995 and 2004. All patients had a follow-up with clinical examination and transvaginal sonography for a median 13 months after surgery.


METHODS
Laparoscopic myomectomy.


RESULTS
Recurrence was defined as the appearance of a leiomyoma on ultrasound examination or identification of leiomyoma during subsequent surgery after the initial surgery. Cox regression (full model) analysis of the possible risk factors for recurrence followed by a stepwise variable selection was performed to eliminate confounding factors. The cumulative probability of leiomyoma recurrence increased steadily during the follow-up period, 11.7% after 1 year, 36.1% after 3 years, 52.9% at 5 years, and reached 84.4% at 8 years. The cumulative probability of reoperation for recurrent leiomyoma was much lower: 6.7% at 5 years and 16% at 8 years. Significant risk factors that were independently associated with cumulative recurrence were age, preoperative number of myoma, preoperative uterine size by pelvic examination, presence of associated pelvic disease, and delivery after laparoscopic myomectomy. The operative time and change of hematocrit were associated with the reoperation. Those who had fewer than 2 myomas before surgery, uterus size less than 13 gestational weeks measured by pelvic examination, no childbirth after laparoscopic myomectomy, and age at index surgery less than 35.5 years showed the lowest recurrence after laparoscopic myomectomy from Classification and Regression trees analysis.


CONCLUSIONS
The risk of recurrence of leiomyoma after laparoscopic myomectomy is linked with the age, preoperative number of leiomyoma, preoperative uterine size, presence of associated pelvic disease, and childbirth after surgery.
Yoo
Eun-Hee
EH
Department of Obstetrics and Gynecology, East West Neo Medical Center, KyungHee University Medical College, 149 Sang-II Dong Kang-Dong Gu, Seoul, Korea. yooe7@khu.ac.kr
Lee
Paul I
PI
Huh
Chu-Yeop
CY
Kim
Dong-Ho
DH
Lee
Byung-Seok
BS
Lee
Jae-Kwan
JK
Kim
Donguk
D
D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D007723:Korea; D010535:Laparoscopy / Q000379:methods; D018231:Leiomyomatosis / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010298:Parity; D036801:Parturition; D011247:Pregnancy; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D014594:Uterine Neoplasms / Q000473:pathology / Q000601:surgery*