Risk factors for postoperative recurrence of cesarean scar endometriosis

Abstract

BackgroundThe increasing global prevalence of cesarean scar endometriosis (CSE) necessitates a thorough understanding of the risk factors for postoperative recurrence, as this is crucial for developing preventive strategies and informed decision-making. ObjectiveTo obtain insight into the clinical risk factors for postoperative recurrence of CSE following open lesion resection. Study DesignThe cohort for this study comprised 272 women, including 26 patients with postoperative recurrence and 246 without recurrence. Various parameters, including baseline characteristics, preoperative, intraoperative, and postoperative conditions, as well as follow-up information, were analyzed. A comparison of these parameters was made between patients with and without postoperative recurrence. Time-to-recurrence analyses were conducted using Cox's univariate and multivariate proportional hazard analyses, the Kaplan-Meier method, and the log-rank test. ResultsThe results revealed significant differences between patients with and without postoperative recurrence in terms of visual analogue scale (VAS) for abdominal pain (P = .008), method of surgery (P < .001), and incision length (P = .002). The Cox proportional hazard model identified VAS for abdominal pain ≥4 as a significant risk factor for postoperative recurrence (hazard ratio [HR], 3.72; 95% confidence interval [CI], 1.65-8.43, P = .002). Additionally, patients who received removal of scar + excision of mass + exploration underneath the scar (named as integrated excision) had a lower risk of recurrence compared to those who received local excision of mass (HR, 0.14; 95% CI, 0.04-0.48, P = .002). Furthermore, older patients (aged ≥35) years were found to have a lower risk of postoperative recurrence than those <35 years (HR, 0.35; 95% CI, 0.12-1.04, P = .058). The depth of involvement was also identified as a meaningful factor in postoperative recurrence for patients with local excision of mass, as determined by the log-rank test (P = .018). ConclusionsThe study highlights that VAS for abdominal pain ≥4 is a risk factor for the recurrence of CSE after open lesion resection. Furthermore, the surgical method of integrated excision was identified as a protective factor.