Abstract
ObjectiveTo explore the risk factors for the recurrence of endometrioma and the risk factors for the recurrence of endometriosis-related pain after long-term follow-up.MethodsThis study retrospectively analyzed 358 women with endometriomas who had a minimum of 5-years follow up after laparoscopic endometrioma excision, which was performed at Peking Union Medical College Hospital from January 2009 to April 2013. All women were divided into recurrence group and nonrecurrence group. Analysis was performed with regard to preoperative history, laboratory analysis, findings during surgery, and symptoms during follow-up, including improvement and recurrence.ResultsThe cumulative incidence rates of recurrence from 5 to 10 years after surgery were 15.4, 16.8, 19.3, 22.5, 22.5, and 22.5%, respectively. Significant differences were found between two groups in terms of age at surgery (RR: 0.764, 95% CI: 0.615–0.949, p = 0.015), duration of dysmenorrhea (RR: 1.120, 95% CI: 1.054–1.190, p < 0.001), presence of adenomyosis (RR: 1.629, 95% CI: 1.008–2.630, p = 0.046), CA125 level (RR: 1.856, 95% CI: 1.072–3.214, p = 0.021) and severity of dysmenorrhea. The severity of dysmenorrhea (RR: 1.711, 95% CI: 1.175–2.493, p = 0.005) and postoperative pregnancy (RR: 0.649, 95% CI: 0.460–0.914, p = 0.013) were significantly correlated with endometrioma recurrence in the multivariate analysis. No significant associations were found between the recurrence rate and gravida, parity, body mass index, infertility, leiomyoma presence, the size of ovarian endometrioma, the presence of deep infiltrating endometriosis, disease stage or postoperative medication.ConclusionsThe severity of dysmenorrhea and postoperative pregnancy were independent risk factors for the recurrence of ovarian endometriomas after surgery during the long-time follow up.
Highlights
Endometriosis is a chronic benign estrogen-dependent disease
The inclusion criteria were as follows: (1) the diagnosis was confirmed by pathologists; (2) ultrasonography was conducted to determine endometrioma recurrence at least 6 months after surgery; and (3) patients were observed without postoperative medications or were treated with postoperative gonadotropin-releasing hormone agonist (GnRHa) injections for 3–6 cycles, with or without a Mirena levonorgestrel-releasing intrauterine device (LNG-IUD). (4) The duration of follow-up was at least 5 years
Abdominal and vaginal ultrasound revealed the presence of bilateral ovarian endometriomas in 46.1% (165/358) of cases and unilateral ovarian endometriomas in 53.9% (193/358) of cases (31.0%, 111 left, 22.9%, 82 right)
Summary
Endometriosis is a chronic benign estrogen-dependent disease. It is observed primarily in patients of reproductive age, and its prevalence in this population is estimated to be 5–10%. Based on the locations of the lesions, the disease is classified as peritoneal, ovarian or deep infiltrating endometriosis [1, 2]. Endometriosis causes impaired quality of life (QoL) for women of reproductive age, and has malignant clinical manifestation despite being a benign disease. Laparoscopic conservative surgery has been considered the gold standard treatment for ovarian endometrioma [3, 4]. Surgery may affect ovarian reserve function, and surgery, especially repeat surgery, is not recommended for ovarian endometrioma recurrence [5,6,7]. The recurrence rate following surgical intervention remains high, even for
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