Abstract
Recurrence of endometriosis after surgery constitutes a serious challenge. Whether there is an evolution of lesion subtypes with each recurrence and whether certain lesions subtypes tend to recur faster than others is not adequately addressed. Medical records of all patients who underwent surgery for endometriosis between 1997 and 2018 in the Department of Gynecology and Obstetrics, University of Bern, were reviewed. Inclusion criteria was surgically confirmed endometriosis recurrence, defined as a subsequent surgery for endometriosis after a previous complete surgical excision of endometriosis lesions. Three subtypes of endometriosis were defined: superficial peritoneal endometriosis (SUP), ovarian endometrioma (OMA), and deep infiltrating endometriosis (DIE). Time to recurrence and variation in endometriosis subtype between the first and recurrent surgeries were the primary outcome measures. Out of the 322 patients with recurrent surgery that were identified, for 234 of them, the endometriosis subtype at first surgery was confirmed and classified (SUP = 56, OMA = 124, DIE = 54). No statistically significant difference was found for time to recurrence between lesion subtypes. SUP compared to the other groups had a higher possibility of presenting with SUP at recurrence (Odds Ratio (OR): 3.65, 95% confidence interval (CI): 1.74–7.51) and OMA compared to the other groups had a higher possibility of presenting with OMA at recurrence (OR: 3.72, 95% CI: 2.04–6.74). Nevertheless, a large number of SUP patients subsequently presented with OMA (10/56: 17.9%) or DIE (27/56: 48.2%) lesions at recurrence. Similarly, a large number of OMA patients subsequently presented with DIE (49/124: 39.5%) lesions at recurrence. In conclusion, although SUP and OMA patients compared to the others are more likely to present with the same subtype at recurrence, increasing lesion subtype severity occurs in a substantial proportion of patients. Time to recurrence is independent from the lesion subtype at first surgery.
Highlights
Endometriosis, characterized by the growth of endometrial-like tissue outside the uterine cavity, is a highly prevalent gynecological disorder of reproductive-aged women worldwide [1,2,3]
Of the women initially presenting with superficial peritoneal endometriosis (SUP), 66.1% returned for recurrent surgery with either an ovarian endometrioma (OMA) (10/56: 17.9%) or deep infiltrating endometriosis (DIE) (27/56: 48.2%), which was statistically significant more when both of these subtypes were combined vs. SUP at recurrence (17/56: 30.4%), (p = 0.0295)
We demonstrate that the time to first recurrent endometriosis surgery is independent from the endometriosis subtype observed at the initial surgery
Summary
Endometriosis, characterized by the growth of endometrial-like tissue outside the uterine cavity, is a highly prevalent gynecological disorder of reproductive-aged women worldwide [1,2,3]. It is a significantly heterogeneous disease, both in phenotype and clinical outcomes that can lead to a significant reduction in quality of life and work productivity [4,5]. The purpose of this study, was to characterize the lesion subtypes in first and subsequent surgeries, examine their evolution and compare the time required for subsequent surgery based on the initial lesion subtype
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