title: Randomised comparison of uterine artery embolisation (UAE) with surgical treatment in patients with symptomatic uterine fibroids (REST trial): 5-year results.
abstract: OBJECTIVE
  To compare the long-term results of uterine artery embolisation (UAE) with surgery for women with symptomatic uterine fibroids.
  
  
  METHODS
  Pragmatic, open, multicentre, randomised trial.
  
  
  METHODS
  Twenty-seven participating UK secondary care centres.
  
  
  METHODS
  Women aged ≥18 years with symptomatic fibroids who were considered to justify surgical treatment.
  
  
  METHODS
  In total, 157 women were randomised (in a 2:1 ratio): 106 to UAE and 51 to surgery (hysterectomy 42; myomectomy nine).
  
  
  METHODS
  Quality of life at 5 years, as assessed by the Short Form General Health Survey (SF-36). Secondary measures included complications, adverse events and the need for further intervention.
  
  
  RESULTS
  There were no significant differences between groups in any of the eight components of the SF-36 scores at 5 years (minimum P = 0.45). Symptom score reduction and patient satisfaction with either treatment was very high, with no group difference. Rates of adverse events were similar in both groups (19% embolization and 25% surgery; P = 0.40). The 5-year intervention rate for treatment failure or complications was 32% (UAE arm) and 4% (surgery arm), respectively. The initial cost benefit of UAE over surgery at 12 months was substantially reduced because of subsequent interventions, with treatments being cost neutral at 5 years.
  
  
  CONCLUSIONS
  We have found that UAE is a satisfactory alternative to surgery for fibroids. The less invasive nature of UAE needs to be balanced against the need for re-intervention in almost a third of patients. The choice should lie with the informed patient.
authors.affiliation: North Glasgow University Hospitals, Gartnavel General Hospital, Glasgow, UK. jon.moss@ggc.scot.nhs.uk
authors.forename: J G
authors.initials: JG
authors.lastname: Moss
authors.forename: K G
authors.initials: KG
authors.lastname: Cooper
authors.forename: A
authors.initials: A
authors.lastname: Khaund
authors.forename: L S
authors.initials: LS
authors.lastname: Murray
authors.forename: G D
authors.initials: GD
authors.lastname: Murray
authors.forename: O
authors.initials: O
authors.lastname: Wu
authors.forename: L E
authors.initials: LE
authors.lastname: Craig
authors.forename: M A
authors.initials: MA
authors.lastname: Lumsden
mesh_terms: D000293:Adolescent; D000328:Adult; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000191:economics; D007889:Leiomyoma / Q000191:economics / Q000601:surgery / Q000628:therapy*; D008875:Middle Aged; D011788:Quality of Life; D016896:Treatment Outcome; D006113:United Kingdom; D055357:Uterine Artery Embolization / Q000009:adverse effects / Q000191:economics; D014594:Uterine Neoplasms / Q000191:economics / Q000601:surgery / Q000628:therapy*