Preoperative treatment with aromatase inhibitor in patients undergoing laparoscopic myomectomy of large uterine myomas

Study Objective: To assess the efficacy of preoperative treatment with letrozole and norethindrone acetate in premenopausal women undergoing laparoscopic myomectomy of large uterine leiomyomas. Design: Open-label prospective trial. Setting: University teaching hospital. Patients: This study included 44 premenopausal women who underwent laparoscopic myomectomy because of large intramural uterine myomas (at least one myoma with larger diameter R 8 cm). Intervention: Study subjects were either treated with letrozole (2.5 mg/day) and norethindrone acetate (2.5 mg/day) continuously in the three months prior to surgery (group A) or received no treatment before surgery (group B). Myoma volume was measured by transvaginal ultrasonography before preoperative hormonal treatment and on the day of surgery. The surgeon was required to estimate the difficulty encountered in the cleavage of the myomas on a 5-point Likert scale. The quality of the sutures performed to restore the uterine wall defects was evaluated by an ultrasonographer blinded to the use of preoperative treatment at 1 week and 3 months from surgery. Measurements and Main Results: The myoma volume was significantly decreased by hormonal treatment (p \ 0.001). The time required to suture the uterine defect (p \ 0.05), the intraoperative blood loss (p \ 0.01) and the decline in hemoglobin levels (p \ 0.05) were significantly decreased in group A compared with group B. There was a trend for the length of surgery to be decreased in group A compared with group B, but this difference was not statistically significant (p = 0.083). The cleavage of the myomas was judged to be more difficult in patients included in group A than in those included in group B (p \ 0.05). The quality of the suture of the uterine wall detect was similar in the two study groups. Conclusion: Preoperative treatment with letrozole and norethindrone acetate may facilitate laparoscopic myomectomy of large uterine leiomyomas.