Preoperative treatment with letrozole in patients undergoing laparoscopic myomectomy of large uterine myomas: a prospective non-randomized study

To assess the efficacy of preoperative treatment with aromatase inhibitors (AIs) in premenopausal women undergoing laparoscopic myomectomy of large uterine myomas.Prospective non-randomized assessor-blind comparative trial.This study included 80 patients undergoing laparoscopic myomectomy of large uterine myomas (≥8cm). Forty patients were treated with a combination of oral letrozole (2.5mg/day) and norethindrone acetate (2.5mg/day) continuously in the three months prior to surgery (group A) and 40 patients received no treatment before surgery (group B). The total operative time (mean±SD, range) was significantly lower in group A (121.5±19.9min; 89-181min) than in group B (134.4±16.8min; 111-185min; p<0.001). The time required to close the hysterotomies (mean±SD, range) was lower in group A (27.1±5.1min; 16-39min) than in group B (37.1±9.6min; 17-57min; p<0.001). The intraoperative blood loss (mean±SD, range) was lower in group A (271.0±125.6ml; 95-625ml) than in group B (460.4±205.7ml; 180-1115ml; p<0.001). No major complication occurred in any case. The cleavage plane was better defined in group B compared with group A (p<0.001). The quality of the myometrial scar, defined by ultrasound evaluation, was similar in the two study groups both at one-week (p=0.356) and at 3-month follow-up (p=0.201).The total operative time, the time required to close the hysterotomies and the intraoperative blood loss significantly decrease after preoperative treatment with letrozole. Future randomized studies should compare the efficacy of preoperative administration of AIs and GnRHa prior to laparoscopic myomectomy.