Long Term Postoperative Recurrence Rates and Fertility Outcomes after Endometrioma CO2-Laser Vaporization: A 5 years Follow-up Experience

Abstract

Although cystectomy remains the gold standard for the surgical treatments of endometriomas, concerns about the negative effect on ovarian reserve are rising. Laser-CO2 vaporization of endometriomas has showed encouraging data on ovarian reserve preservation, postoperative pregnancy rates and recurrency. The aim of this study was to assess postoperative recurrence rate and pregnancy rate in patients with endometriomas managed by CO2 fiber laser vaporization after at least 5 years following surgery. Retrospective study. Italian tertiary center from October 2023 to February 2024. We included women aged >18 years who underwent laparoscopic CO2 fiber laser vaporization for endometriomas. Age ≥ 40 years, previous ovarian surgery, previous salpingectomy or hysterectomy, negative histologic finding for endometriosis or any findings of malignancy at histology were exclusion criteria. Ovarian endometriomas were vaporized through laparoscopic CO2 fiber laser. After surgery, patients were included in a surveillance program with periodic clinical follow-up. Seventy-eight patients were included. The mean age was 33.2±4.6 years, the basal AMH was 2.7 ± 1.9 ng/mL and the median diameter of the endometriomas was 4(3-5)cm. The median duration of follow-up was 72.5 months(67-84.5). After surgery, 65.5%(n=36) of women with reproductive desire achieved a pregnancy, 55.6% spontaneously and 44.4% through Assisted Reproduction Techniques, with a mean time to pregnancy of 17.7±18.1 months. A Kaplan-Meier curve for the 7 patients who experienced an ipsilateral recurrence showed that the median time to recurrence was 26 months and the estimated rate of disease-free patients was 91.03% at 100 months (95% CI 82.10%-95.62%). CO2 fiber laser vaporization is an effective and safe surgical treatment of ovarian endometriomas, combining the advantage of being an ovarian tissue-sparing technique with long-term post-operative recurrence rate comparable with that described in literature for the cystectomy.