title: Long-term risk of fibroid recurrence after laparoscopic myomectomy.
abstract: OBJECTIVE
  The use of laparoscopic myomectomy as a surgical treatment for uterine leiomyoma is associated with low intraoperative morbidity and short hospitalization. Limited data about the long-term outcome of this surgical approach are available. The aims of this study were to estimate the risk of uterine fibroid recurrence after laparoscopic myomectomy and to identify factors contributing to the rate of fibroid relapse.
  
  
  METHODS
  Between 1996 and 2003, 331 patients underwent laparoscopic myomectomy to treat uterine leiomyoma in our hospital; 224 of these patients consented to participate in our 2009 follow-up survey. Clinical symptomatic uterine leiomyoma recurrence was defined as relapse. Recurrence rates at 24 and 60 months post-operatively were calculated for the study population. Fisher's exact tests were used to examine the impacts of factors previously linked to an increased risk of fibroid recurrence, including (1) patient age at the time of initial surgery, (2) pre-operative body mass index, (3) number and localization of uterine leiomyoma removed, and (4) pregnancy and (5) delivery after laparoscopic myomectomy on fibroid recurrence in our study cohort.
  
  
  RESULTS
  We observed 75 recurrences in 224 patients. The cumulative risk of recurrence was 4.9% at 24 months and 21.4% at 60 months post-operatively. An age of 30-40 years and the presence of more than one fibroid at the time of initial laparoscopic myomectomy were identified as factors significantly increasing the risk of symptomatic recurrence after laparoscopic myomectomy (31.25% and 38.71%, respectively; both p<0.01).
  
  
  CONCLUSIONS
  Patients with multiple uterine leiomyoma and those in the third decade of life should be counselled thoroughly about the risk of recurrence prior to laparoscopic myomectomy. The low observed recurrence rate in peri- and postmenopausal patients in our study may support the use of laparoscopic myomectomy as a uterus-preserving surgical alternative beyond the reproductive period.
authors.affiliation: Department of Gynaecology and Obstetrics, Jena University Hospital, Friedrich-Schiller-University Jena, Bachstraße 18, 07743 Jena, Germany.
authors.forename: M P
authors.initials: MP
authors.lastname: Radosa
authors.affiliation: Department of Gynaecology and Obstetrics, Jena University Hospital, Friedrich-Schiller-University Jena, Bachstraße 18, 07743 Jena, Germany.
authors.forename: Z
authors.initials: Z
authors.lastname: Owsianowski
authors.affiliation: Department of Gynaecology and Obstetrics, Jena University Hospital, Friedrich-Schiller-University Jena, Bachstraße 18, 07743 Jena, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Mothes
authors.affiliation: Department of Gynaecology and Obstetrics, Jena University Hospital, Friedrich-Schiller-University Jena, Bachstraße 18, 07743 Jena, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Weisheit
authors.affiliation: Department of Gynaecology and Obstetrics, Jena University Hospital, Friedrich-Schiller-University Jena, Bachstraße 18, 07743 Jena, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Vorwergk
authors.affiliation: Department of Gynaecology and Obstetrics, Jena University Hospital, Friedrich-Schiller-University Jena, Bachstraße 18, 07743 Jena, Germany.
authors.forename: F A
authors.initials: FA
authors.lastname: Asskaryar
authors.affiliation: Department of Gynaecology and Obstetrics, Jena University Hospital, Friedrich-Schiller-University Jena, Bachstraße 18, 07743 Jena, Germany.
authors.forename: O
authors.initials: O
authors.lastname: Camara
authors.affiliation: Department of Gynaecology and Obstetrics, Jena University Hospital, Friedrich-Schiller-University Jena, Bachstraße 18, 07743 Jena, Germany.
authors.forename: T S
authors.initials: TS
authors.lastname: Bernardi
authors.affiliation: Department of Gynaecology and Obstetrics, Jena University Hospital, Friedrich-Schiller-University Jena, Bachstraße 18, 07743 Jena, Germany. Electronic address: direktion-gyn@med.uni-jena.de.
authors.forename: I B
authors.initials: IB
authors.lastname: Runnebaum
mesh_terms: D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D007889:Leiomyoma / Q000473:pathology / Q000601:surgery*; D018231:Leiomyomatosis / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D012307:Risk Factors; D047368:Tumor Burden; D063186:Uterine Myomectomy; D014594:Uterine Neoplasms / Q000473:pathology / Q000601:surgery*
keywords: Laparoscopic myomectomy; Recurrence rate; Reproductive surgery; Symptomatic leiomyoma; Uterine fibroid