Laparoscopic Radiofrequency Ablation Vs Laparoscopic Myomectomy In The Treatment Of Symptomatic Uterine Leiomyomas: A Meta-Analysis Of Randomized Controlled Trials

This meta-analysis reviews the evidence from randomized controlled trials (RCTs) which compare laparoscopic radiofrequency ablation (LAP-RFA) and laparoscopic myomectomy (LM), two uterine sparing procedures for managing symptomatic uterine leiomyomas (UL). A comprehensive search was performed on PubMed, EMBASE®, and Cochrane Library through October 2020. The inclusion criteria were RCTs comparing LAP-RFA with LM in women with UL. RCTs comparing LAP-RFA with other treatments were excluded. Outcomes of interest were changes in quality of life (QOL) measures such as EQ-5D, uterine fibroid symptom QOL (UFSQOL), health-related QOL (HRQOL) and clinical endpoints such as mean operative blood loss (MOBL), length of hospital stay (LOS), and mean number of fibroids excised. Fixed-effects (FE) and random-effects (RE) models were used to quantify pooled effectiveness of LAP-RFA vs LM. Mean difference (MD), 95% CI, p-value were computed for clinical endpoints using R software (2020). A total of 579 citations were found and after removing the duplicates, 495 title and abstracts were screened for eligibility. Four studies were eligible for qualitative review and 2 studies (LUSTOR Germany, and TRUST Canada) reporting the results of 96 total patients (47 Lap-RFA, 49 LM), met the inclusion criteria. Improvement in QOL endpoints were similar for Lap-RFA and LM (EQ-5D: p=0.8750, UFSQOL: p=0.7019, HRQOL: p=0.6220). LAP-RFA reduced MOBL compared to LM with statistical significance (FE: MD=-43.93 ml (95% CI: -61.42, -26.45, p<0.001); RE: MD=-44.64 ml (95% CI: -66.21, -23.08; p<0.001)). Moreover, LAP-RFA also reduced the LOS postoperatively compared to LM (FE: MD=-9.47 hours (95% CI: -13.13, -5.81, p<0.001); RE: MD=-11.44 hours (95% CI: -27.80, 4.93; p>0.1707)). Overall, LAP-RFA treated more fibroids than LM but the results were not statistically significant (RE: MD=0.72 (95% CI: -0.17, 1.61; p>0.114). LAP-RFA was associated with shorter LOS, lower MOBL and similar QOL outcomes compared to LM.