Post-operative dienogest following conservative endometriosis surgery: A systematic review and meta-analysis

Abstract

<h3>Objectives</h3> To determine the impact of postoperative dienogest on recurrence of endometriosis following conservative surgery. <h3>Methods</h3> The following databases were searched from inception to March 2019: Ovid MEDLINE, Ovid EMBASE, PubMed (Non-Medline records only), EBM Reviews - Cochrane Central Register of Controlled Trials, Web of Science, LILACS, clinicaltrials.gov and International Standard Randomised Controlled Trial Number Registry. Observational and randomized controlled studies with pre-menopausal women undergoing conservative surgery for endometriosis followed by post-operative dienogest treatment for at least 6 months were included. Primary outcome was the rate of endometriosis/endometrioma recurrence. For studies with a comparator group, we compared post-operative suppression with dienogest to no treatment. <h3>Results</h3> After screening 328 studies, 10 met inclusion criteria (9 retrospective, 1 prospective) representing 2031 patients (1184 treated, 846 controls). Among patients treated with dienogest, there were 2.11 recurrences per 100 women (95% CI: 1.43 to 3.11, 10 studies, 1184 patients, I2 = 0% fixed effects model). Comparatively, those managed expectantly had a significantly higher incidence of disease recurrence (28.61 events/100 women; 95% CI: 25.66 to 31.74, 6 studies, 846 patients, I2 = 83% fixed effects model). The odds of recurrence were significantly lower in women treated with dienogest compared to those without postoperative medical treatment (log odds -1.96, 95% CI -2.53 to -1.38, p<0.001; 6 studies, 1184 patients). Four studies were found to be good quality, four were fair, and two were poor. <h3>Conclusions</h3> Women treated with dienogest following conservative endometriosis surgery have a significantly lower rate of disease recurrence compared to those not receiving post-operative hormonal suppression.