Outcomes in Women Undergoing Conservative Compared to Definitive Surgery for Chronic Pelvic Pain: A Prospective Cohort

Abstract

Study Objective To compare chronic pelvic pain and quality-of-life outcomes in women undergoing conservative or definitive surgery for pelvic pain. Design A prospective cohort analytic study (Canadian Task Force Classification II-2). Setting A tertiary referral center for endometriosis in Vancouver, Canada. Patients or Participants A total of 676 patients underwent surgical interventions for pelvic pain between December 2013 and July 2016. 517 patients underwent conservative surgery whereas 159 patients underwent definitive surgery. Interventions Patients underwent either conservative or definitive surgery for chronic pelvic pain. Conservative surgery was defined as excision and/or cautery of endometriosis. Definitive surgery involved a hysterectomy and/or bilateral salpingo-oophorectomy. Measurements and Main Results Chronic pelvic pain (differentiated from dysmenorrhea or dyspareunia) was determined at baseline, 1-year, and 2-years on a patient-reported numeric rating scale (0-10). Similarly, the Endometriosis Health Profile (EHP)-30 questionnaire functional pain scale (0-100%, lower score indicating better quality-of-life) was determined at baseline, 1 year, and 2 years. The average age of women undergoing surgery was 34 ± 8 for conservative surgery and 39 ± 6 for definitive surgery. There was no statistically significant difference in self-reported chronic pelvic pain between the two groups at baseline (7 ± 2 vs. 7 ± 2, p = 0.35), at 1-year (6 ± 2 vs. 6 ± 2, p = 0.56), or at 2-years (6 ± 2 vs. 6 ± 3, p = 0.51). For quality-of-life, there was no difference in baseline EHP-30 scores (54% vs. 57%, p = 0.31). However, a statistically significant difference in EHP-30 scores was identified for definitive vs. conservative surgery at 1-year (34% vs. 20%, p Conclusion There was no difference in self-reported chronic pelvic pain after follow-up from conservative vs. definitive surgery. However, definitive surgery (hysterectomy +/- BSO) was associated with improved quality-of-life. This improvement may be a result of the elimination of dysmenorrhea.