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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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.
