Endometrioma post-surgical-recurrence risk factors

Pregnancy after surgery seems beneficial for preventing endometrioma recurrence

Key Points

Highlights:

• A personalized management scheme and appropriate follow-up are required for the surgical treatment of ovarian endometrioma patients with risk factors for recurrence to improve the clinical outcome.
• There is a need for further large-scale analytic studies for the validation of the results of this review.

Importance:

• Postoperative endometrioma recurrence may reach a prevalence of 44%, and these recurrences may result in an important physical and mental burden during the reproductive years of many women.

What’s done here:

• This is a systematic literature review and meta-analysis, searching potential risks for ovarian endometrioma recurrence.
• The main aim was to evaluate the association between the risks and relapse outcomes following surgery.

Key results:

• Endometrioma post-surgical relapse is closely related to age at surgery, CA-125 levels, cyst size, dysmenorrhea, previous endometriosis surgery, medication before surgery, revised American Society for Reproductive Medicine (rASRM) score.
• Pregnancy following ovarian endometrioma surgery is a protective factor against endometrioma recurrence. 
• Risks concerning bilateral involvement, combination with adenomyosis, or post-operative medication on endometrioma relapse need further investigation.

Limitations:

• The relatively small number of studies and patients involved in this meta-analysis may result in limited reliability.
• Most of the studies were retrospective in design, which could lead to a selection bias about patient characteristics.
• The majority of these studies (8/9) were conducted in Asia and may not be geographically generalized.
• The diagnosis of recurrence after surgical excision using ultrasound instead of histological confirmation could also be regarded as another pitfall. 

Lay Summary

Jiang and associates from Dailan Medical University, China published their review manuscript “Risk factors for ovarian endometrioma recurrence following surgical excision: a systematic review and meta‑analysis” in the June 2021 issue of "Archives of Gynecology and Obstetrics".

The most common form of endometriosis, "ovarian endometrioma" has an estimated prevalence of 17% -44% among endometriosis patients. Surgery is the standard treatment for endometrioma, but there is a risk of recurrence about 21.5% after 2 years and 40–50% after 5-years follow-up.

Recurrences after OMA surgeries result in an important physical and mental burden during the reproductive years of many women and could also be a factor in premature ovarian failures.

In this review, the publications before October 2020 in several databases were explored for potential risk factors in endometrioma recurrence and the association between these factors and relapse outcomes after surgery. This systematic review and meta-analysis was performed on the basis of Meta-analysis of Observational Studies in Epidemiology guidelines and documented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist.

The pooled evidence of this meta-analysis showed that risk factors significantly associated with the relapse of endometrioma were age at surgery, CA125 level, cyst size, dysmenorrhea, endometriosis-related surgery history, pre-operative medication, stage by revised American Society for Reproductive Medicine (rASRM) score. An additional remarkable finding was that post-operative pregnancy indicated a protective role in preventing endometrioma recurrence after surgery.

The effect of bilateral involvement, combination with adenomyosis, or post-operative medication on endometrioma relapse needs further investigation.

A personalized management scheme including extensive surgery and post-operative follow-up for improving the prognosis in patients with endometrioma is required. The authors concluded that “further studies on large scale are necessary for confirming our findings for the inevitable limitations involved in this meta-analysis”.

Research Source: https://pubmed.ncbi.nlm.nih.gov/34148122/