MR imaging evaluation of fibroid clearance following open myomectomy for massive/multiple symptomatic fibroids.
OBJECTIVE
To evaluate the technical success of total fibroid clearance at open myomectomy for massive and/or multiple symptomatic fibroids using MR imaging (MRI) as the imaging modality.


METHODS
The study group comprised 27 women [mean age 37.4 ± 6.9 years (range 27-53)] who underwent open myomectomy for the treatment of massive/multiple symptomatic fibroids at our institution between January 2009 and April 2010. Myomectomy was performed with the intention of achieving complete fibroid clearance. Pre- and postmyomectomy MRI was performed to assess changes in uterine volume and fibroid burden. Periprocedural data (including blood loss and complications) and relief of clinical symptoms at follow-up were also recorded.


RESULTS
The mean time to MRI and clinical follow-up was 10 months (range 6-15 months). The mean uterine volume premyomectomy was 795 ± 580 cc and postmyomectomy was 123 ± 70 cc (p < 0.001). The mean percentage reduction in uterine volume was 80.3 % (range 43.0-98.1 %). Of the 10/27 (37.0 %) women with residual fibroids at follow-up: 7 patients had fibroids measuring up to 1 cc in volume, 3 patients had fibroids measuring up to 6 cc. Postoperative adnexal seromas were observed in 6/27 (22.2 %) patients. The clinical success rates of myomectomy amongst the 22/27 (81 %) responders were: 73 % for menorrhagia, 64 % for pain, and 36-64 % for mass-related symptoms.


CONCLUSIONS
Using MRI, we have confirmed that open myomectomy can achieve total or near-total fibroid clearance in the majority of patients with massive and/or multiple fibroids.
Department of Radiology, St George's Hospital NHS Trust, Blackshaw Road, London SW17 0QT, UK. n.wijesekera@doctors.net.uk
Nevin T
NT
Wijesekera
Giovanni
G
Mauri
Sahana
S
Gupta
Anna-Maria
AM
Belli
Isaac T
IT
Manyonda
D015746:Abdominal Pain / Q000209:etiology / Q000601:surgery; D000328:Adult; D016063:Blood Loss, Surgical; D001810:Blood Volume; D016009:Chi-Square Distribution; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018231:Leiomyomatosis / Q000150:complications / Q000473:pathology* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008595:Menorrhagia / Q000209:etiology / Q000601:surgery; D008875:Middle Aged; D018365:Neoplasm, Residual; D009929:Organ Size; D049291:Seroma / Q000175:diagnosis / Q000209:etiology; D016896:Treatment Outcome; D047368:Tumor Burden; D063186:Uterine Myomectomy / Q000009:adverse effects; D014594:Uterine Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery; D014599:Uterus / Q000473:pathology*