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

Authors

DOI:

https://doi.org/10.18370/2309-4117.2019.49.12-16

Keywords:

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

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.

Author Biographies

В. А. Потапов, SI “Dnipropetrovsk medical academy of the MOH of Ukraine”, Dnipro

MD, professor, head of Obstetrics and Gynecology Department

В. І. Івах, Medical center “Medicover”, Dnipro

Obstetrician gynecologist

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Published

2019-12-06

Issue

Section

Tumors and pretumoral pathology