Randomised comparison of uterine artery embolisation (UAE) with surgical treatment in patients with symptomatic uterine fibroids (REST trial): 5-Year results

J. G. Moss, K. G. Cooper, A. Khaund, L. S. Murray, G. D. Murray, O. Wu, L. E. Craig, M. A. Lumsdenf

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Abstract

Objective: To compare the long-term results of uterine artery embolisation (UAE) with surgery for women with symptomatic uterine fibroids. Design: Pragmatic, open, multicentre, randomised trial. Setting: Twenty-seven participating UK secondary care centres. Sample: 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). Main outcome measures: 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.

Original languageEnglish
Pages (from-to)936-944
Number of pages9
JournalBJOG: an International Journal of Obstetrics and Gynaecology
Volume118
Issue number8
DOIs
Publication statusPublished - 1 Jul 2011
Externally publishedYes

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Uterine Artery Embolization
Leiomyoma
Uterine Myomectomy
Secondary Care Centers
Therapeutics
Health Surveys
Treatment Failure
Hysterectomy
Patient Satisfaction
Health Care Costs
Multicenter Studies
Cost-Benefit Analysis
Quality of Life
Outcome Assessment (Health Care)

Cite this

Moss, J. G. ; Cooper, K. G. ; Khaund, A. ; Murray, L. S. ; Murray, G. D. ; Wu, O. ; Craig, L. E. ; Lumsdenf, M. A. / Randomised comparison of uterine artery embolisation (UAE) with surgical treatment in patients with symptomatic uterine fibroids (REST trial) : 5-Year results. In: BJOG: an International Journal of Obstetrics and Gynaecology. 2011 ; Vol. 118, No. 8. pp. 936-944.
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abstract = "Objective: To compare the long-term results of uterine artery embolisation (UAE) with surgery for women with symptomatic uterine fibroids. Design: Pragmatic, open, multicentre, randomised trial. Setting: Twenty-seven participating UK secondary care centres. Sample: 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). Main outcome measures: 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.",
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Randomised comparison of uterine artery embolisation (UAE) with surgical treatment in patients with symptomatic uterine fibroids (REST trial) : 5-Year results. / Moss, J. G.; Cooper, K. G.; Khaund, A.; Murray, L. S.; Murray, G. D.; Wu, O.; Craig, L. E.; Lumsdenf, M. A.

In: BJOG: an International Journal of Obstetrics and Gynaecology, Vol. 118, No. 8, 01.07.2011, p. 936-944.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Randomised comparison of uterine artery embolisation (UAE) with surgical treatment in patients with symptomatic uterine fibroids (REST trial)

T2 - 5-Year results

AU - Moss, J. G.

AU - Cooper, K. G.

AU - Khaund, A.

AU - Murray, L. S.

AU - Murray, G. D.

AU - Wu, O.

AU - Craig, L. E.

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N2 - Objective: To compare the long-term results of uterine artery embolisation (UAE) with surgery for women with symptomatic uterine fibroids. Design: Pragmatic, open, multicentre, randomised trial. Setting: Twenty-seven participating UK secondary care centres. Sample: 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). Main outcome measures: 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.

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