Patients with Pelvic Pain Most Likely to Benefit from Endometriosis Surgery

The more pain a woman with endometriosis experiences the more likely it is that her quality of life will improve after surgery.

Key Points

Highlights:

• The level of pain a woman with endometriosis experiences seems to correlate with the likelihood of improvement following surgery.
• Chronic pelvic pain seems to be the most significant independent predictive factor that influences the quality of life score of women with endometriosis following surgery. 

Importance:

• The identification of predictive factors influencing women’s quality of life can guide decision making about surgical treatment.

What's done here:

• Researchers assessed the effect of endometriosis surgery on patients' quality of life using the SF-36 questionnaire.
• Data on demographic factors, medical history, grade, treatment, along with symptoms- QoL, and fertility self-report written questionnaires were collected from 981 patients with endometriosis who underwent laparoscopic surgery at  CHU Clermont-Ferrand in France.

Key results:

• 47% of patients with stage 4 endometriosis showed improvement following surgery in the physical component of the questionnaire.
• Only 26, 31.3, and 27.5% of patients with stage 1, 2, and 3 endometriosis respectively showed an improvement in the physical component score after surgery.
• Of patients with chronic pelvic pain, 44% showed an improvement in the physical component score and 38% showed an improvement in the mental component score of the questionnaire.
• Above percentages were 23% for the physical and 24% for the mental component score for women without chronic pelvic pain.
• Fertile patients were more likely to show higher rates of improvement in the physical component score of the questionnaire after surgery compared to infertile patients.

Limitations:

• According to the authors, the SF-36 questionnaire has limitations relating to endometriosis and the endometriosis health profile (EHP)-30 scale should be used where possible. 

Lay Summary

Women who experience higher levels of pain are more likely to show improvement in their quality of life (QoL) following endometriosis surgery, according to a study published in The Journal of Minimally Invasive Gynecology. Chronic pelvic pain seems to be the most significant independent factor that can predict whether surgery will lead to a change in the quality of life. 

Identifying predictive factors about the potential effect of surgery on quality of life can help doctors and patients make more informed choices about surgery. In other words both it can help them decide whether they should proceed with endometriosis surgery based on the likelihood of the patient’s quality of life improving.  

For the study, researchers led by Dr. Nicolas Bourdel at CHU Clermont-Ferrand in France evaluated the quality of life of 981 patients with endometriosis who underwent laparoscopic surgery. They did this using the SF-36 questionnaire, a measure of health status comprised of 36 items. 

Following the statistical analysis of patients answers, researchers found that almost half (47 percent) of patients with stage 4 endometriosis – i.e. the most severe stage of the disease – showed an improvement in their physical component score following surgery. This percentage was 26, 31.3, and 27.5 for patients with stage 1, 2, and 3 endometriosis respectively.  

Moreover, the researchers found that more patients who had chronic pelvic pain showed improvements in their physical and mental component scores following surgery than those who did not have chronic pelvic pain. In other words, it was more likely that patients’ physical and mental component scores would improve following surgery if they had chronic pelvic pain before surgery.

Finally, the researchers found that fertile patients were more likely to show higher rates of improvement in their physical component score following surgery compared to infertile patients.

“Chronic pelvic pain is the most significant independent predictive factor, hence those patients with pelvic pain appear to benefit the most from surgery in terms of QoL,” the authors wrote.

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/31146030