Postoperative treatment and pregnancy points to decreased recurrence risk for ovarian endometriosis

Postoperative recurrence can be encountered in women who underwent laparoscopic ovarian cystectomy despite excision of all the endometriotic lesions.

Key Points

Highlights:

• The higher the postoperative pregnancy and postoperative medical treatment, the lower the risk of recurrence in patients after laparoscopic ovarian cystectomy for endometriosis.

Importance:

• Women operated for ovarian endometriosis should be informed about the risk of postoperative recurrence and preventive measures to minimalize recurrence.

What’s done here?

• This is a retrospective cross-sectional study, conducted at a single hospital with an infertility clinic.
• Women who underwent laparoscopic cystectomy with suspicion of endometriosis and endometriosis diagnosed by pathology, with at least one-year follow-up are included.
• Demographic and clinical characteristics including age, BMI, menarche, marriage status, parity, previous endometriotic surgery, symptoms, ovarian endometriosis diameter, pre-and postoperative medical treatment, pelvic endometriosis, adenomyosis, rASRM score, pregnancy, and recurrence time were collected from hospital records.
• Patients were analyzed in two groups according to recurrencewhich was diagnosed ultrasonographically.

Key results:

• A total of 106 patients [mean age of 32.4years] were included in the study.
• 24 patients (22.6%) had postoperative recurrence while the remaining patients (82 women) did not.
• There was no significant difference between recurrence and non-recurrence groups regarding age, BMI, size of the cyst, parity, preoperative symptoms, and associated diseases.
• Risk factors for postoperative recurrence were determined as postoperative use of medical treatment and postoperative pregnancy.
• Other evaluated variables were not significantly different in terms of risk factors of postoperative recurrence.

Strengths and Limitations

• The retrospective design, selection bias and relative small number of patients are the limitations.
• Having minimal missing data, and enough sample size were the strengths of the present study.

Lay Summary

Endometriosis is a disease most frequently diagnosed in women of reproductive age and negatively affects the quality of life.

The most common localization for endometriosis is ovaries with a prevalence of 17-44%. Laparoscopic ovarian cystectomy performed as excision or ablation has been accepted as the gold standard approach in these patients. Excision of all visible endometriotic lesions, and adhesiolysis are recommended to restore ovarian anatomy. However, postoperative recurrence can be encountered in women who underwent laparoscopic ovarian cystectomy despite excision of all the endometriotic lesions.

Wacharachawana et al., from Thailand, published a study titled “Recurrence Rate and Risk Factors for the Recurrence of Ovarian Endometriosis after Laparoscopic Ovarian Cystectomy” in the journal named "BioMed Research International".

The authors aimed to detect risk factors for postoperative recurrence in women operated for ovarian endometriosis studying 106 patients. All the demographical and clinical characteristics of the patients were compared between the "recurrence" and "non-recurrence" groups. They determined the recurrence risk as 22.6% (24/106 patients). Mean size of ovarian endometrioma was 54.5mm, and the postoperative pregnancy rate was 43.4%.

There was no significant difference between the two groups regarding age, body mass index, size of the ovarian cyst, parity, preoperative symptoms, and associated diseases. The variables examined including age, body mass index, parity, surgical history, preoperative symptoms, size and bilaterality of the cyst, and associated disease were not found to be a risk factor for postoperative recurrence. Only the presence of postoperative medical treatment and postoperative pregnancy were found to indicate significantly low risk for postoperative recurrence.     

“Postoperative medical treatment and pregnancy were the protective factors associated with a lower recurrence rate of ovarian endometriosis after laparoscopic cystectomy." they added. 

Research Source: https://pubmed.ncbi.nlm.nih.gov/33575338/