High reintervention rates observed after surgical myomectomy

High reintervention rates observed after surgical myomectomy | Image Credit: © natali_mis - © natali_mis - stock.adobe.com.

Reintervention is often necessary following surgical myomectomy for uterine leiomyomas, according to a recent study published in the American Journal of Obstetrics & Gynecology.¹

Uterine leiomyomas are benign tumors that lead to pelvic pain, abnormal uterine bleeding, and potential reproductive dysfunction in women. Experts recommend myomectomy as treatment for women wishing to preserve fertility, but this method has been linked to leiomyoma recurrence rates up to 57%.

The 3 most common molecular subtypes of uterine leiomyomas include tumors exhibiting specific mutations in mediator complex subunit 12 (MED12), tumors showing high mobility group AT-hook 2 (HMGA2) overexpression, and tumors with biallelic inactivation of fumarate hydratase (FH).

Recent developments have enhanced the use of laparoscopic myomectomy, such as a tool for predicting the need for blood transfusions in this procedure.² The model had an area under the operating characteristic curve of 0.69 when using 4 parameters vs 0.78 when using 6 parameters.

According to investigators, the repeat occurrence of uterine leiomyomas is “poorly understood regarding clonality and molecular characteristics.”¹ A study was conducted to evaluate reintervention characteristics following myomectomy.

Data was obtained from a prior study of 234 myomectomy patients aged 17 to 45 years. Fifty-one percent of participants received open abdominal myectomy, with 97% of laparoscopic myomectomies utilizing morcellator. A median of 2 leiomyomas were removed in open abdominal myectomies vs 1 is laparoscopic myectomies.

Investigators collected formalin-fixed paraffin-embedded (FFPE) leiomyoma samples from surgical interventions through August 2019. Samples from myomectomies before the index procedure were also obtained.

FH status was determined through immunohistochemical staining with an anti-2-succinylcysteine antibody. An anti-HMGA2 antibody was used to measure HMGA2 expression levels, while MED12 exons 1 and 2 were measured through sanger sequencing. Fifty-two tumors underwent whole-exome sequencing with 12 matching normal samples.

A leiomyoma-related reintervention was reported in 20% of patients during a median follow-up period of 11.4 years. Patients were aged a mean 41 years during the first repeat procedure, vs a mean 34 years at the index myomectomy. Hysterectomy was reported in 51% of patients, making it the most common procedure.

Women with reintervention had a significantly increased median number of leiomyomas removed during the index operation vs those without reintervention. Reintervention rates for open abdominal myomectomy and laparoscopic myomectomy were 26% and 19%, respectively, which investigators did not consider statistically significant.

Reintervention rates varied from 12% in patients with only wild type leiomyomas to 33% in those with only FH-deficient leiomyomas. Investigators did not consider rates between groups to be statistically significant.

Postoperative parity was reported as a significant risk factor for reintervention, while history of myomectomy was nearly significant. The number of removed leiomyomas was also an independent risk factor, with a hazard ratio of 1.21.

Postoperative parity and older age and index myomectomy were linked to reduced reintervention risk, with hazard ratios of 0.23 and 0.94, respectively. No associations with reintervention were found for median diameter of the largest leiomyoma or median body mass index.

MED12 mutations were less common in leiomyomas from reinterventions vs increased rates of HMGA2 overexpression and FH-deficiency. The leiomyoma driver alteration was the same in the index and nonindex leiomyomas for 67% of patients.

These results indicated a high prevalence of reintervention after myomectomy. Investigators concluded “the reintervention risk is similar after laparoscopic and abdominal myomectomy.”

Reference

1. Khamaiseh S, Äyräväinen A, Maare Arffman M, et al. Clinical and molecular risk factors for repeat interventions due to symptomatic uterine leiomyomas. Am J Obstet Gynecol. 2025;232:110.e1-23. doi:10.1016/j.ajog.2024.06.051.
2. Krewson C. New tool predicts blood transfusion needs in laparoscopic myomectomy. Contemporary OB/GYN. July 12, 2024. January 13, 2025. https://www.contemporaryobgyn.net/view/new-tool-predicts-blood-transfusion-needs-in-laparoscopic-myomectomy