Long-term symptoms, quality of life, and fertility after colorectal resection for endometriosis: extended analysis of a randomized controlled trial comparing laparoscopically assisted to open surgery

Touboul, Cyril; Ballester, Marcos; Dubernard, Gil; Zilberman, Sonia; Thomin, Anne; Daraı̈, Émile

doi:10.1007/s00464-014-3880-4

Cited by 40 publications

(30 citation statements)

References 32 publications

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“…Nineteen studies were prospective in nature [24,27,29,30,32,37,38,[40][41][42][43][44][48][49][50]52,55,56,59], 2 were randomized controlled trials (one of which was an extended analysis of a randomized controlled trial) [20,28], and 20 were retrospective studies [11,21− (Table 1) [11,20−59]. The mean follow-up period ranged between 12 and 108 months.…”

Section: Study Characteristics: Descriptive Analysismentioning

confidence: 99%

Recurrence after Surgery for Colorectal Endometriosis: A Systematic Review and Meta-analysis

Bendifallah¹,

Vesale

Daraı̈³

et al. 2020

Journal of Minimally Invasive Gynecology

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The recurrence rate after colorectal surgery for endometriosis is up to 50% at 5 years. The aim of the current review and meta-analysis was to assess recurrence associated with shaving, disc excision, and segmental resection for endometriosis with colorectal involvement. Data Sources: A systematic review was performed by searching the PubMed, ClinicalTrials.gov, EMBASE, Cochrane Library, and Web of Science databases for publications before February 28, 2019, using the terms "colorectal endometriosis" and "recurrence" in English. The outcome measure was histologically proven recurrence 1 year after the index surgery. Methods of Study Selection: Studies rated as good or fair by a study quality assessment tool were included. Two reviewers independently assessed the quality of the studies; discrepancies were discussed, and if a consensus was not reached, a third reviewer was consulted. Tabulation, Integration, and Results: Of 156 relevant published trials, 41 were systematically reviewed and 4 were included in the meta-analysis. The risk of recurrence was higher after rectal shaving than after both segmental resection (odds ratio [OR], 5.53; 95% confidence interval [CI], 2.33−13.12; I 2 = 0%; p = .001) and disc excision for histologically proven recurrence (OR, 3.83; 95% CI, 1.33−11.05; I 2 = 0%; p = .01). This difference was not significant when comparing disc excision with segmental resection (OR, 2.63; 95% CI, 0.8−8.65; I 2 = 0%; p = .11). Conclusion: The current analysis shows that the risk of recurrence is lower when segmental resection or disc excision is performed than when rectal shaving is performed. This finding is important when deciding the most appropriate surgical management.

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Section: Study Characteristics: Descriptive Analysismentioning

confidence: 99%

Recurrence after Surgery for Colorectal Endometriosis: A Systematic Review and Meta-analysis

Bendifallah¹,

Vesale

Daraı̈³

et al. 2020

Journal of Minimally Invasive Gynecology

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“…A large prospective study of over 200 women having surgery with or without bowel resection for severe endometriosis shows a cumulative live birth rate of 36%, 50% and 67% at 1, 2 and 3 years post‐index surgery, with no difference whether bowel resection was undertaken or not, with half achieving pregnancy with expectant management and the remainder with assisted reproductive technology . Similar outcomes are reported from a French team performing open or laparoscopic bowel resection, where cumulative pregnancy rates following surgery were 60% with a median of 19 months follow‐up although it was reported in an extended analysis from the same group that pregnancy after expectant management only occurred in the laparoscopy group . In the most recent series of 111 women having bowel resection for deeply invasive disease, 73% of women were pregnant at 12 months of follow‐up with the majority after expectant management .…”

Section: Deeply Invasive Endometriosis Bowel Resection and Fertilitymentioning

confidence: 53%

Surgical treatment is an excellent option for women with endometriosis and infertility

Abbott

2017

Aust NZ J Obst Gynaeco

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K E Y W O R D S endometriosis, infertility, surgery SURGERY IN PREVIOUS UNSUCCESSFUL IVF Surgery is often successful after previous failed IVF cycles and this has been previously reported, with 22/29 (75%) women with endometriosis having multiple failed IVF cycles treated surgically, with 15/22 (68%) pregnant with expectant management. 19This demonstrates that where IVF has been unsuccessful, the role of surgery should still be considered and in fact may be of substantial benefit. CONCLUSIONSSo how do we wrap all this up? It is clear that surgery has a number of advantages for the often symptomatic woman with endometriosis with regards to pain management and reduction in her pelvic symptoms of dyspareunia, dyschesia and non-menstrual pelvic pain is likely to improve pregnancy from expectant management as her quality of life is improved and she is more likely to have regular timed intercourse. It should also be apparent that the first attempt at fertility should be the best and the adage here is that it is better to peek and shriek than peek and poke. If you cannot finish the surgery with removal of disease, then you should not start and refer to a specialist centre which can undertake optimal disease removal with minimal risk and a multidisciplinary team where appropriate. Deeply invasive disease can and has been successfully removed with improvements in fertility as well as the benefits of symptom reduction. Many women, and their families, will want choices in how they may approach future parenthood and that is not always the one-size-fits-all approach of IVF. Certainly it is an option, but an invasive and expensive option, so at least there should be the choice of a second invasive and less expensive option in surgery.

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“…This study demonstrated that laparoscopy can provide patients with a higher pregnancy rate. Touboul, Cyril [29] also believe that laparoscopy can improve postoperative pregnancy rate of patients, but most patients have a successful pregnancy within 2 years after surgery. Many professors believe that surgery combined with ART can be the rst choice for patients.…”

Section: Discussionmentioning

confidence: 99%

Fertility outcomes of deep infiltrating endometriosis with fertility desire——a meta analysis

shen

Feng

Jiang

et al. 2020

Preprint

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Abstract Background: And the incidence of endometriosis has been increased in recent years. Deep infiltrating endometriosis is the most advanced type of endometriosis. The treatments for patients with DIE and fertility desire are controversial. Materials and Methods: We had search Pubmed, OVID Medline, Cochrane Library published before 2019-10-31, According to the inclusion criteria and exclusion criteria, a total of 17 articles were selected. A 95% confidence interval (CI) was used for clinical pregnancy data, and a random-effect model was used for meta-analysis. Subgroup analysis and sensitivity analysis were performed using Review manager 5.3. Results: Among patients with fertility desire, 370/1142 (32.40%) conceived spontaneously after surgery, compared with 306/1108(27.62%) got pregnant after surgery and assisted reproductive technology（P=0.36,I2=82%）.There is no significant statistical significance in this comparison and the heterogeneity is high. Then，we performed subgroup analysis and found that the heterogeneity was not caused by fertility status ,surgical methods or study characteristics. Conclusion: Through this meta-analysis, we think that surgery combined ART or not doesn’t affect the pregnancy rate in patients with DIE. But further investigations are required to determine fertility outcomes according to age, endometrioma, adenomyosis, ASRM scores and so on.

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Long-term symptoms, quality of life, and fertility after colorectal resection for endometriosis: extended analysis of a randomized controlled trial comparing laparoscopically assisted to open surgery

Abstract: Symptoms and QOL improvements after colorectal resection last for over 4 years without difference between the routes. Thank to a lower intra- and postoperative complications and higher spontaneous pregnancy rate, laparoscopic colorectal resection should be the first surgical approach.

Cited by 40 publications

References 32 publications

Recurrence after Surgery for Colorectal Endometriosis: A Systematic Review and Meta-analysis

Recurrence after Surgery for Colorectal Endometriosis: A Systematic Review and Meta-analysis

Surgical treatment is an excellent option for women with endometriosis and infertility

Fertility outcomes of deep infiltrating endometriosis with fertility desire——a meta analysis

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