Abstract
Objective
Although the postoperative use of hormonal treatment for endometriosis is recommended
in the European Society of Human Reproduction and Embryology guidelines to prevent
the recurrence of endometriosis-associated dysmenorrhoea, hormonal treatment may not
be necessary for all patients who undergo surgical treatment for endometriosis. The
aim of this study was to clarify the determinant factors that predict the recurrence
of endometriosis after surgery in order to develop personalized hormonal treatment
recommendations. Factors associated with the recurrence of endometrioma and pain were
investigated independently to identify the likelihood of recurrence in each individual
patient.
Study design
Between 2008 and 2013, 352 patients underwent surgery and were diagnosed with endometriosis
based on pathological findings at the study hospital. Among these patients, 191 experienced
a recurrence of endometrioma in the absence of pre- or postoperative hormonal treatment.
Various clinical factors such as pre-operative pain, intra-operative findings and
postoperative improvement of pain were compared between patients who experienced recurrence
after surgery and those who did not.
Results
The cumulative 5-year recurrence rate of endometrioma was 28.7% among the 191 patients
who did not undergo pre- or postoperative hormonal treatment. Significant differences
were detected in maximum tumour diameter, revised American Society for Reproductive
Medicine score (r-ASRM score), operative time and operative blood loss between patients
in the recurrent endometrioma group and the non-recurrent endometrioma group; only
the r-ASRM score was significantly correlated with recurrence of endometrioma in the
multivariate analysis. The cumulative 5-year rate of persistent/recurrent pain was
33.4%. There were significant differences in the postoperative improvement of pain
between the persistent/recurrent pain group and the non-recurrent pain group according
to the univariate and multivariate analyses.
Conclusion
This study suggests that the risk factors for recurrence of endometrioma differ from
the risk factors for recurrence of pain. The use of postoperative hormonal treatment
should be considered based on the dominant risk factors and needs of each patient.
Keywords
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References
- European Society of Human Reproduction and Embryology: ESHRE guideline: management of women with endometriosis.Hum Reprod. 2014; 29: 400-412
- Low-dose oral contraceptive pill for dysmenorrhea associated with endometriosis: a placebo-controlled, double-blind, randomized trial.Fertil Steril. 2008; 90: 1583-1588
- Postoperative oral contraceptive exposure and risk of endometrioma recurrence.Am J Obstet Gynecol. 2008; 198: e1-e5
- Long-term oral contraceptive pills and postoperative pain management after laparoscopic excision of ovarian endometrioma: a randomized controlled trial.Fertil Steril. 2010; 94: 464-471
- Long-term adjuvant therapy for the prevention of postoperative endometrioma recurrence: a systematic review and meta-analysis.Acta Obstet Gynecol Scand. 2013; 92: 8-16
- Postoperative administration of monophasic combined oral contraceptives after laparoscopic treatment of ovarian endometriomas: a prospective, randomized trial.Am J Obstet Gynecol. 2000; 183: 588-592
- Post-operative oral contraceptive use reduces the risk of ovarian endometrioma recurrence after laparoscopic excision.Hum Reprod. 2009; 24: 3042-3048
- 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
- Long-term follow-up after laparoscopic treatment for endometriosis: multivariate analysis of predictive factors for recurrence of endometriotic lesions and pain.Eur J Obstet Gynecol Reprod Biol. 2011; 157: 78-83
- Pain and ovarian endometrioma recurrence after laparoscopic treatment of endometriosis: a long-term prospective study.Fertil Steril. 2010; 93: 716-721
- Ovarian endometrioma: severe pelvic pain is associated with deeply infiltrating endometriosis.Hum Reprod. 2012; 27: 702-711
- Clinicopathologic risk factors for recurrence of ovarian endometrioma following laparoscopic cystectomy.Acta Obstet Gynecol Scand. 2013; 92: 278-284
- Risk factors for recurrence and re-recurrence of ovarian endometriomas after laparoscopic excision.J Obstet Gynaecol Res. 2011; 37: 581-585
- Chronic pelvic pain in endometriosis: an overview.J Clin Med Res. 2013; 5: 153-163
- Patterns of and risk factors for recurrence in women with ovarian endometriomas.Obstet Gynecol. 2007; 109: 1411-1420
- Recurrence rate of endometriomas following a laparoscopic cystectomy.Acta Obstet Gynecol Scand. 2006; 85: 1120-1124
- Recurrence of ovarian endometrioma after laparoscopic excision: risk factors and prevention.J Obstet Gynaecol Res. 2014; 40: 230-236
Revised American Society for Reproductive Medicine classification of endometriosis: 1996. Fertil Steril 1997;67:817–21.
- Post-operative cyclic oral contraceptive use after gonadotrophin-releasing hormone agonist treatment effectively prevents endometrioma recurrence.Hum Reprod. 2010; 25: 3050-3054
- Recurrence factors in women underwent laparoscopic surgery for endometrioma.Minerva Chir. 2014; 69: 277-282
- Recurrence of ovarian endometrioma after laparoscopic excision.Hum Reprod. 2006; 21: 2171-2174
- High rate of endometriosis recurrence in young women.J Pediatr Adolesc Gynecol. 2011; 24: 376-379
- Gruppo Italiano di Studio Endometriosi: determinants of short term recurrence rate of endometriosis.Eur J Obstet Gynecol Reprod Biol. 2005; 121: 216-219
- Endometriosis and pelvic pain: epidemiological evidence of the relationship and implications.Hum Reprod Update. 2005; 11: 595-606
- Preoperative pain and recurrence risk in patients with peritoneal endometriosis.Gynecol Endocrinol. 2010; 26: 230-235
Article info
Publication history
Published online: August 04, 2016
Accepted:
July 27,
2016
Received in revised form:
June 21,
2016
Received:
March 11,
2016
Identification
Copyright
© 2016 Elsevier Ireland Ltd. All rights reserved.
