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

Abstract

Please cite this paper as: Moss J, Cooper K, Khaund A, Murray L, Murray G, Wu O, Craig L, Lumsden M. Randomised comparison of uterine artery embolisation (UAE) with surgical treatment in patients with symptomatic uterine fibroids (REST trial): 5‐year results. BJOG 2011;118:936–944. 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.