Research Article| Volume 203, P56-60, August 2016

Evaluation of risk factors for the recurrence of ovarian endometriomas



      To evaluate the risk factors for the recurrence of ovarian endometrioma after laparoscopic cystectomy.

      Study design

      Reproductive aged patients who underwent laparoscopic ovarian endometriotic cystectomy and with histopathologically confirmed diagnosis of ovarian endometrioma were evaluated retrospectively. Histopathologic specimens were reevaluated and histopathologic characteristics of ovarian endometriotic cysts (thickness of cyst wall, thickness of fibrosis [ToF], thickness of ovarian tissue, the number of follicles per cyst, the depth of penetration [DoP] of endometrial tissue into the cyst wall) were determined. Along the determined histopathologic findings, demographic characteristics (age at surgery, number of pregnancies), clinical symptoms (dysmenorrhea, infertility), intraoperative findings (revised American Society for Reproductive Medicine [rASRM] stage), imaging features (bilaterality, cyst diameter), and biochemical parameters (Ca125, Ca19.9, Ca15.3) were evaluated as possible risk factors for the recurrence of endometrioma. The variables with p < 0.2 in univariate analysis were introduced into regression analysis to determine the risk factors for recurrence.


      There were statistically significant differences in age group (≤35 years and >35 years), the ToF and DoP between patients with recurrence and those with no recurrence. In Cox regression analysis, age ≤35 years and DoP were significant risk factors for presence of recurrence. DoP, ToF, preoperative cyst diameters in ultrasonographic examination were inversely correlated with recurrence interval. In multivariate regression analysis, the DoP was found the only significant risk factor for the recurrence interval. 1.2 mm of DoP was found as the optimum cut off value for presence of recurrence according to Youden index criteria in ROC curve analyze. The sensitivity (62.9%), specificity (75%) were obtained at the cut off value of 1.2 mm for DoP.


      Histopathological features of ovarian endometriotic cyst may have important roles on predicting the recurrence of the endometrioma. Predicting the recurrence risk of particular patient is very important in future management of the disease. Knowing the recurrence risk of an endometrioma will help in deciding the optimal treatment modalities for each individual patient. High risk patients should be offered appropriate treatments according to the clinical status without delay and low risk patients should be protected from overtreatment.


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        • Busacca M.
        • Vignali M.
        Ovarian endometriosis: from pathogenesis to surgical treatment.
        Curr Opin Obstet Gynecol. 2003; 15: 321-326
        • Hart R.J.
        • Hickey M.
        • Maouris P.
        • Buckett W.
        Excisional surgery versus ablative surgery for ovarian endometriomata.
        Cochrane Database Syst Rev. 2008; (CD004992)
        • Kennedy S.
        • Bergqvist A.
        • Chapron C.
        • et al.
        ESHRE guideline for the diagnosis and treatment of endometriosis.
        Hum Reprod. 2005; 20: 2698-2704
        • Alborzi S.
        • Momtahan M.
        • Parsanezhad M.E.
        • Dehbashi S.
        • Zolghadri J.
        • Alborzi S.
        A prospective, randomized study comparing laparoscopic ovarian cystectomy versus fenestration and coagulation in patients with endometriomas.
        Fertil Steril. 2004; 82: 1633-1637
        • Busacca M.
        • Marana R.
        • Caruana P.
        • et al.
        Recurrence of ovarian endometrioma after laparoscopic excision.
        Am J Obstet Gynecol. 1999; 180: 519-523
        • Koga K.
        • Takemura Y.
        • Osuga Y.
        • et al.
        Recurrence of ovarian endometrioma after laparoscopic excision.
        Hum Reprod. 2006; 21: 2171-2174
        • Kikuchi I.
        • Takeuchi H.
        • Kitade M.
        • Shimanuki H.
        • Kumakiri J.
        • Kinoshita K.
        Recurrence rate of endometrioma following a laparoscopic cystectomy.
        Acta Obstet Gynecol. 2006; 85: 1120-1124
        • Mais V.
        • Guerriero S.
        • Ajossa S.
        • Angiolucci M.
        • Paoletti A.M.
        • Melis G.B.
        The efficiency of transvaginal ultrasonography in the diagnosis of endometrioma.
        Fertil Steril. 1993; 60: 776-780
        • Sesti F.
        • Capozzolo T.
        • Pietropolli A.
        • Marziali M.
        • Bollea M.R.
        • Piccione E.
        Recurrence rate of endometrioma after laparoscopic cystectomy: a comparative randomized trial between post-operative hormonal suppression treatment or dietary therapy vs. placebo.
        Eur J Obstet Gynecol Reprod Biol. 2009; 147: 72-77
        • Muzii L.
        • Bianchi A.
        • Bellati F.
        • et al.
        Histologic analysis of endometriomas: what the surgeon needs to know.
        Fertil Steril. 2007; 87: 362-366
        • Oh H.K.
        • Sin J.I.
        • Kim J.H.
        • Hong S.Y.
        • Lee T.S.
        • Choi Y.S.
        Effect of age and stage of endometriosis on ovarian follicular loss during laparoscopic cystectomy for endometrioma.
        Int J Gynaecol Obstet. 2011; 114: 128-132
        • Sengoku K.
        • Miyamoto T.
        • Horikawa M.
        • et al.
        Clinicopathologic risk factors for recurrence of ovarian endometrioma following laparoscopic cystectomy.
        Acta Obstet Gynecol Scand. 2013; 92: 278-284
        • Exacoustos C.
        • Zupi E.
        • Amadio A.
        • et al.
        Recurrence of endometriomas after laparoscopic removal: sonographic and clinical follow-up and indication for second surgery.
        J Minim Invasive Gynecol. 2006; 13: 281-288
        • Liu X.
        • Yuan L.
        • Shen F.
        • Zhu Z.
        • Jiang H.
        • Wei S.
        Patterns of and risk factors for recurrence in women with ovarian endometriomas.
        Obstet Gynecol. 2007; 109: 1411-1420
        • Porpora M.G.
        • Pallante D.
        • Ferro A.
        • Crisafi B.
        • Bellati F.
        • Benedetti Panici P.
        Pain and ovarian endometrioma recurrence after laparoscopic treatment of endometriosis: a long-term prospective study.
        Fertil Steril. 2010; 93: 716-722
        • Moini A.
        • Arabipoor A.
        • Ashrafinia N.
        Risk factors for recurrence rate of ovarian endometriomas following a laparoscopic cystectomy.
        Minerva Med. 2014; 105: 295-301
        • Campo S.
        • Campo V.
        • Gambadauro P.
        Is a positive family history of endometriosis a risk factor for endometrioma recurrence after laparoscopic surgery?.
        Reprod Sci. 2014; 21: 526-531
        • Kim M.L.
        • Kim J.M.
        • Seong S.J.
        • Lee S.
        • Han M.
        • Cho Y.J.
        Recurrence of ovarian endometrioma after second-line, conservative, laparoscopic cyst enucleation.
        Am J Obstet Gynecol. 2014; 210 (216.e1–6)
        • Augoulea A.
        • Alexandrou A.
        • Creatsa M.
        • Vrachnis N.
        • Lambrinoudaki I.
        Pathogenesis of endometriosis: the role of genetics, inflammation and oxidative stress.
        Arch Gynecol Obstet. 2012; 286: 99-103
        • Gaetje R.
        • Kotzian S.
        • Herrmann G.
        • Baumann R.
        • Starzinski-Powitz A.
        Invasiveness of endometriotic cells in vitro.
        Lancet. 1995; 346: 1463-1464
        • Imai A.
        • Takagi A.
        • Tamaya T.
        Gonadotropin-releasing hormone analog repairs reduced endometrial cell apoptosis in endometriosis in vitro.
        Am J Obstet Gynecol. 2000; 182: 1142-1146
        • Bulun S.E.
        • Lin Z.
        • Imir G.
        • et al.
        Regulation of aromatase expression in estrogen-responsive breast and uterine disease: from bench to treatment.
        Pharmacol Rev. 2005; 57: 359-383
        • Guo S.W.
        Nuclear factor-kappaB (NF-kappaB): an unsuspected major culprit in the pathogenesis of endometriosis that is still at large?.
        Gynecol Obstet Invest. 2006; 63: 71-97