How beneficial is colorectal surgery for patients with deep endometriosis?

Colorectal surgery provides a better quality of life and symptom relief in deep endometriosis, study shows.

Key Points

Highlight

• Regardless of the technique, surgical intervention improves the quality of life and provides pain relief in patients with colorectal deep endometriosis.

Importance

• Deep endometriosis patients suffer from more pain and gastrointestinal symptoms.
• Surgical resection of the lesions is shown to be beneficial.

What’s done here

• Two surgical methods segmental resection and discoid resection used in the treatment of deep colorectal endometriosis were compared in terms of long-term outcomes.
• 77 patients who underwent SR and DR were reached via telephone and followed up.
• The pain scores, QoL scores, and lower anterior resection syndrome (LARS) scores were evaluated.

Key results

• The quality of life scores showed a significant increase at the first visit and remained stable at the second for both patient groups.
• The pain scores were also significantly decreased.
• Dysuria was the only symptom that increased at the second visit after a decrease at first in the SR group.
• LARS scores did not show any difference in both groups over time.

Strengths and Limitations

• The strengths include the long observation period and the final argument in favor of surgery in symptomatic patients.
• Limitations include the high rate of patients lost to follow-up, the retrospective nature of the study possibly causing a bias, and the lack of evaluation of other factors such as concomitant adenomyosis and intake of oral contraceptives.

Lay Summary

In cases of deep endometriosis, which causes more severe pain and gastrointestinal symptoms, the patient's quality of life and fertility outcomes are negatively affected. Surgical intervention is thought to be the optimal treatment method in colorectal deep endometriosis cases, however, there is controversy when it comes to the best surgical approach a segmental resection or the partial resection of the wall along with the endometriotic lesion - a discoid resection. Each technique has its own complications and advantages.

The team led by Dr. Hudelist evaluated the long-term surgical outcomes of the patients who underwent laparoscopic segmental resection or discoid resection for deep endometriotic lesions in terms of pain scores, quality of life, and lower anterior resection syndrome (LARS) scores. LARS is a complication that can be encountered with both techniques. The study was published in the September 2022 issue of the journal Acta Obstetrica et Gynecologica Scandinavica.

A total of 77 patients were followed up for around 35 months at the first visit and 86 months at the second visit on average from a cohort of 134 patients. Of these patients, 19% underwent discoid resection and 81% underwent segmental resection.  Postoperative data were collected via telephone interviews. The quality of life was assessed using a scale of 0-10 as well as the pain scores. In the evaluation of gastrointestinal function, LARS scores were used with five items including incontinence for flatus, incontinence for liquid stools, frequency, clustering, and urgency. It was seen that for both groups the quality of life scores was statistically significantly improved at the first visit and remained stable until the second. The pain scores decreased in the same manner. Only the dysuria symptom showed some changes between the two visits in the segmental resection group. It was discussed that as a result of the study, surgical intervention was proven to increase the quality of life of patients by providing pain relief. The long-term benefits of both techniques were said to not differ from one another.

In terms of LARS scores, no significant difference was observed in both group. The authors stated that this shows there is a low rate of major complications and sequelae after surgery for colorectal deep endometriosis. When the patients were asked if they would have the surgery again knowing all its consequences, a majority of them from both groups (80% in the discoid resection group and 96% in the SR group) said yes.

To conclude, colorectal surgery for deep endometriosis either by discoid resection or segmental resection is shown to be effective in providing patients with long-term benefits.

Research Source: https://pubmed.ncbi.nlm.nih.gov/35822249/