Efficacy of preoperative gonadotropin-releasing hormone agonist therapy for laparoscopic myomectomy

Objective: In this article, we evaluate efficacy of preoperative gonadotropin-releasing hormone agonist (GnRHa) therapy prior to laparoscopic myomectomy (LM). Materials and Methods: There were 161 subjects who underwent LM between 1995 and 2007. They were divided into two groups: group A (58 cases), who underwent four to six cycles of preoperative GnRHa therapy, and group B (103 cases), the untreated group. To determine the efficacy of preoperative GnRHa therapy, the recurrence rate after LM was evaluated by comparing the number of myoma confirmed on the preoperative MRI and the number actually enucleated. For this purpose, the cases were divided into the matched group (group I) and the discrepancy group (group II) whose enucleated number was smaller than the estimated number. Results: No statistically significant difference was observed between groups A and B in the surgical performance. The 4 year cumulative recurrence rate was estimated to be 27.3% for group A and 25.8% for group B without any significant difference. In group A, the postoperative recurrence rate was statistically significantly higher in group II (44.4%) than in group I (12.1%). While in group I, it was 12.1% in group A and 14.3% in group B without a statistically significant difference. Discussion: Preoperative GnRHa therapy did not compromise surgical outcome or recurrence rate, rather it acted as an effective pretreatment for LM in terms of expanding its indications. Also, completing surgery by enucleating all the myomas without any left in situ, as confirmed by the precise preoperative myoma status on the MRI, contributes to a reduction in the postoperative recurrence rate.