Laparoscopic bipolar coagulation of uterine vessels to treat symptomatic myomas in women with elevated Ca 125.

STUDY OBJECTIVE

To assess laparoscopic bipolar coagulation of uterine vessels (LBCUV) for symptomatic myomas in women with elevated CA 125 (>35 U/ml).

DESIGN

Prospective, longitudinal study (Canadian Task Force classification II-1).

SETTING

Private practice, university-affiliated hospital.

PATIENTS

Forty-six women (age 30-50 yrs) with symptomatic myomas and elevated CA 125 level.

INTERVENTION

Laparoscopic bipolar coagulation of uterine vessels performed over 10 months.

MEASUREMENTS AND MAIN RESULTS

All patients underwent successful LBCUV and coagulation of anastomotic site of uterine arteries with ovarian arteries without intraoperative complication. One, 3, and 6 months after treatment, respectively, 52.2%, 65.2%, and 71.7% of women reported improvement in menorrhagia, 19.6%, 45.7%, and 56.5% noted improvement in dysmenorrhea, and 6.5%, 16.1%, and 38.7% had improvement in bulk-related symptoms. Average reduction in uterine volume was 9.1%, 16.9%, and 38.3% and average reduction in dominant myoma was 12.1%, 23.9%, and 59.1% at those times; the average reduction of CA 125 in all patients was 39.8, 75.4, and 126.1U/ml.

CONCLUSION

Symptoms were improved and uterine volume and dominant myoma were reduced by LBCUV. The CA 125 level fell during follow-up in 40 patients (87.0%). Improvement in symptoms, especially menorrhagia, and shrinkage of uterine volume and dominant myoma seemed to be more pronounced in women with decreased than in those without decreased CA 125 after treatment (p = 0.045). The CA 125 level may be a valuable indicator for monitoring the efficacy of LBCUV.