EDITORIAL: EVALUATING GYNECOLOGICAL SURGICAL PROCEDURES

In an accompanying editorial, Roy M. Pitkin, M.D., from the University of California, Los Angeles, and James R. Scott, M.D., from the University of Utah, Salt Lake City, discuss these two randomized controlled studies. "The clinical trials by Kuppermann et al and Hurskainen et al represent important efforts to place a common surgical procedure on firmer, evidence-based grounds."

"One fairly consistent finding in the two investigations is the proportion of women in the control group who, for whatever reason, had hysterectomies (42 percent in the Finnish trial and 52 percent in the U.S. trial). If this result applies to the general population - and in view of the recruitment [of participants for the studies] problems it may not - then women with unsatisfactory response to such first-line 'medical' therapy for excessive uterine bleeding can be counseled that further conservative therapy carries approximately a 50 percent likelihood of ultimately leading to a hysterectomy. ... Does it mean that surgery will likely be necessary eventually anyway, so perhaps better sooner than later, sparing the woman continued symptoms? Or does it mean that there is a 50 percent chance of avoiding the hysterectomy and these odds are worth taking to avoid a major operation?"

The editorial authors suggest that additional randomized clinical trials with longer follow-up are needed "to determine whether these (or other) more conservative treatments are more efficacious and cost-effective in the long run than hysterectomy."

(JAMA. 2004; 291:1503-1504. Available post-embargo at JAMA.com)

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Contact: Eve Harris
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JAMA and Archives Journals
23-Mar-2004