Strategy for prevention of uterine leiomyoma recurrence in combination with adenomiosis after organ-conserving operations in reproductive aged women

Abstract

Aim of the study: to reduce the number of relapses and improve the reproductive function of women after surgical removal of uterine leiomyoma (LM). Materials and methods: the study included 76 women of reproductive age who underwent organ-preserving surgical treatment for LM. Women were divided into two groups depending on the adenomyosis presence. Group I included 35 women with isolated LM, group II included 41 women with LM in combination with adenomyosis. Groups I and II were divided into 4 subgroups: in Ia and IIa subgroups during preparation for surgery patients received one of the agonists of gonadotropin releasing hormone (GnRH) for 3 months. In Ib and IIb subgroups suppressive therapy was not performed prior to surgical treatment. After a myomectomy women of I and II groups received one of the GnRH agonists for the first three months, followed by the low-dose combined oral contraceptive. The choice of funds was justified on the results of an immunohistochemical study of the Ki-67 antigen expression (proliferation marker), estrogen and progesterone receptors, and cyclooxygenase-2 (COX-2). Group IIb women were additionally prescribed non-hormonal therapy with fibrinolytic (streptokinase) and proteolytic (streptodornase) enzymes, as well as herbal antiproliferative agent containing indole-3-carbinol and epigallocatechin-3-gallate. Results of the study: an immunohistochemical study showed that in women who did not receive suppressive therapy before surgery (Ib and IIb groups) Kі-67 antigen expression in the tumor nodes was significantly increased. Almost 2 times greater was the difference between the Ki-67 antigen expressions in the LM nodes with the adenomyosis combination. GnRH agonists did not inhibit the expression of estrogen and progesterone receptors. COX-2 expression was significantly higher than in intact myometrium. In women with combined uterine pathology the number of cells with a positive immunohistochemical reaction to COX-2 was 6.4 times higher than with isolated LM. Conclusions: myomectomy surgery only partially solves the problems of reproductive health restoration in women with combined uterine pathology. The proposed long-term suppressive therapy made it possible to reduce the tumor relapses number by almost 2.6 times after surgical organ-preserving treatment and to improve reproductive function in almost every third woman.

Keywords

• uterine leiomyoma in combination with endometriosis
• myomectomy
• postoperative therapy
• long-term surgery results
• tumor recurrence