Laparoscopic management of bowel endometriosis: resection margins as a predictor of recurrence

Nirgianakis, Konstantinos; McKinnon, Brett; Imboden, Sara; Knabben, Laura; Gloor, Beat; Mueller, Christoph

doi:10.1111/aogs.12490

Cited by 39 publications

(17 citation statements)

References 18 publications

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“…The standardized laparoscopic surgical technique for DIE performed in our clinic has been described previously [24]. SUP was treated by excision via monopolar needle or scissors.…”

Section: Surgical Techniquementioning

confidence: 99%

Recurrence Patterns after Surgery in Patients with Different Endometriosis Subtypes: A Long-Term Hospital-Based Cohort Study

Nirgianakis

McKinnon

et al. 2020

JCM

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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.Laparoscopic surgery is associated with decreased overall pain, both at 6 and 12 months after surgery [6]. However, despite complete removal of endometriotic tissue, a high proportion of patients will require additional surgery due to endometriosis recurrence. In a recent UK population-based report, 48% of patients with endometriosis received surgical treatment. Approximately one-fifth of these patients required further surgical treatment, within three years of the index procedure [7]. Other studies have reported total recurrence rates of 21.5% and 40%-50% at two and five years, respectively [8,9].Endometriosis lesions are a heterogenous group of lesions that are currently split into three subtypes based on the location and infiltration depth: superficial peritoneal endometriosis (SUP), ovarian endometrioma (OMA), and deep infiltrating endometriosis (DIE) [10,11]. Although patients with SUP may suffer from pelvic pain, OMA and DIE generally cause heavier symptoms, have more serious long-term complications, are more difficult t...

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“…The standardized laparoscopic surgical technique for DIE performed in our clinic has been described previously [24]. SUP was treated by excision via monopolar needle or scissors.…”

Section: Surgical Techniquementioning

confidence: 99%

Recurrence Patterns after Surgery in Patients with Different Endometriosis Subtypes: A Long-Term Hospital-Based Cohort Study

Nirgianakis

McKinnon

et al. 2020

JCM

Self Cite

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“…As far back as 1990, surgeons have suggested that excision of macroscopic endometriosis lesions might leave behind microscopic implants (4,5). Other authors have focused their studies on bowel endometriosis and attempted estimating the risk of residual microscopic implants on the bowel after disc excision (6) or colorectal resection (7)(8)(9)(10). It is unclear whether such residual microimplants or bowel occult microscopic endometriosis (BOME) contribute to postoperative symptoms or recurrences of macronodules, because studies remain vague concerning the degree of risk of such outcomes (10).…”

mentioning

confidence: 99%

Mapping of bowel occult microscopic endometriosis implants surrounding deep endometriosis nodules infiltrating the bowel

Badescu

Roman

Aziz

et al. 2016

Fertility and Sterility

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“…Recurrence rate for shaving was reported at 22.2%, for discoid resection 5.17%, and in segmental resection 2.19%; these rates were significantly different [37]. Positive bowel resection margins as well as age <31 years and body mass index ≥23kg/m2 appear to be important independent predictors of disease recurrence [40].…”

Section: /6mentioning

confidence: 90%

Identical Ovarian and Deep Pelvic Endometriosis with Colorectal Involvement in Monozygotic Twins: A Case Report and Review of the Literature

Miller¹

2017

BJSTR

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Laparoscopic management of bowel endometriosis: resection margins as a predictor of recurrence

Abstract: Positive bowel resection margins as well as age <31 years and body mass index ≥23 kg/m(2) appear to be independent predictors of disease recurrence.

Cited by 39 publications

References 18 publications

Recurrence Patterns after Surgery in Patients with Different Endometriosis Subtypes: A Long-Term Hospital-Based Cohort Study

Recurrence Patterns after Surgery in Patients with Different Endometriosis Subtypes: A Long-Term Hospital-Based Cohort Study

Mapping of bowel occult microscopic endometriosis implants surrounding deep endometriosis nodules infiltrating the bowel

Identical Ovarian and Deep Pelvic Endometriosis with Colorectal Involvement in Monozygotic Twins: A Case Report and Review of the Literature

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