Is it possible to predict recurrence after ovarian endometriosis surgery?

Some factors are associated with a higher risk of recurrence after ovarian cyst debulking, study shows

Key Points

Highlight

• A thorough clinical evaluation of the patients with ovarian endometriosis who are candidates for surgery in terms of rates of recurrence is important in providing them with good care.

Importance

• Higher recurrence rates after surgical treatment of ovarian endometriosis reduce the quality of life of patients.
• Identifying the risk factors for recurrence is crucial in patient management.

What’s done here

• This is a retrospective study of ovarian endometrioma patients who underwent cyst debulking surgery and followed up for at least 12 months.
• It aimed to evaluate the factors that are associated with recurrence.
• The data including the age, hospital stay, preoperative dysmenorrhea, infertility, adhesions, adenomyosis, myomas, pelvic ectasia, ovarian cyst diameter, laterality, revised American Fertility Society (r-AFS) score-staging, least function score, endometriosis fertility index (EFI) score, postoperative gonadotropin-releasing hormone agonist (GnRH-a) treatment, and presence of postoperative pregnancy were statistically evaluated.

Key results

• A statistically significant difference was found between postoperative recurrence and the r-AFS score, preoperative dysmenorrhea, r-AFS staging, EFI score, combined myoma, and postoperative pregnancy.
• r-AFS score, combined myoma, and preoperative dysmenorrhea were found to be risk factors for recurrence.
• EFI score and postoperative pregnancy were found to be protective factors.
• Medical treatment with GnRH-a did not have any protective effects.

Lay Summary

The current treatment methods for endometriosis both have their flaws: the medical treatment is sometimes ineffective and the surgical treatment comes with a high rate of recurrence. Even though new surgical modalities have been developed, laparoscopic cyst removal continues to be the first choice in many cases. 

Huang et. al performed a study in which they retrospectively analyzed the clinical and follow-up data of ovarian endometriosis patients who underwent laparoscopic cyst debulking surgery with the aim to scrutinize the factors that are related to recurrence after surgery. The study was published in the March 2022 issue of the journal "Annals of Translational Medicine".

All 289 patients were evaluated using the data including their age, days spent at the hospital, preoperative combined dysmenorrhea, combined infertility, combined adhesions, adenomyosis or myomas and pelvic ectasia, the maximum diameter of ovarian cysts, laterality of the cysts, revised American Fertility Society (r-AFS) score and staging which is based on the degree of the lesions, least function score, endometriosis fertility index (EFI) score which predicts spontaneous pregnancy after laparoscopic surgery, postoperative gonadotropin-releasing hormone agonist (GnRH-a) treatment duration, and presence of postoperative pregnancy.

A statistically significant difference was found between postoperative recurrence and the r-AFS score, preoperative dysmenorrhea, r-AFS staging, EFI score, combined myoma, and postoperative pregnancy. Of these, r-AFS score, combined myoma, and preoperative dysmenorrhea were found to be risk factors for recurrence in the multifactorial analysis. In contrast, EFI score and postoperative pregnancy were found to be protective factors. The authors stated that the higher the r-AFS score was, the more aggressive the lesion was which resulted in an incomplete removal during surgery and eventually a higher rate of recurrence. A higher fertility index score meant there were fewer adhesions and less inflammation which was evaluated as a protective factor against recurrence.

It was also pointed out that treatment with GnRH-a did not have any protective effects in this study as opposed to the literature findings. They concluded by saying that the r-AFS score was found to be an independent predictor of recurrence in ovarian endometriosis and evaluating the patients pre-and postoperatively will be helpful in the management of the disease. New studies are needed in this area regarding the other types: superficial peritoneal and deep infiltrative endometriosis.

Research Source: https://pubmed.ncbi.nlm.nih.gov/35402582/