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

Bendifallah, Sofiane; Vesale, Elie; Daraı̈, Émile; Thomassin‐Naggara, Isabelle; Bazot, Marc; Tuech, Jean‐Jacques; Abo, Carole; Roman, Horace

doi:10.1016/j.jmig.2019.09.791

Cited by 32 publications

(18 citation statements)

References 60 publications

(95 reference statements)

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“…A relevant data is the recurrence rate that we observed, allowing us to say that 3.5 women in 10 who underwent surgical treatment presented new endometriotic lesions. This value is similar to those obtained by other authors, with recurrence rates ranging from 25% to 43% 4,13,14,17 . More important than numbers, is the analysis of risk factors for the resurgence of the disease to guide the post‐surgical management.…”

Section: Discussionsupporting

confidence: 89%

Risk factors for recurrence of deep infiltrating endometriosis after surgical treatment

Yela

Vitale

Vizotto

et al. 2021

J of Obstet and Gynaecol

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Aim To evaluate the frequency of complications and factors associated with the recurrence of endometriosis in women with deep infiltrating endometriosis (DIE) undergoing surgical treatment. Methods A retrospective observational cohort study with 72 women who underwent surgery and followed up by DIE at the University of Campinas from 2007 to 2017. The variables analyzed were clinical characteristics, use and type of drug treatment before and after surgery, operative time and complications inherent to the procedure, as well as the recurrence of lesions on imaging. Results The mean age of women was 39.7 ± 6.3 years and the mean follow‐up was 4.56 ± 2.60 years. Complications were reported in 16.6% of surgeries and recurrence of lesions in 34.7%. The risk of intraoperative complications was higher in the presence of lesions of the bowel and in those who used intramuscular progestin before surgery. A higher risk of recurrence was observed among those who did not use hormonal treatment or used a levonorgestrel‐releasing intrauterine device (LNG‐IUD) in the postoperative period. Conclusion Women with DIE have a high rate of complications during surgical treatment and a higher risk of recurrence when they did not receive hormonal treatment or when treated with LNG‐IUD after surgery.

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Section: Discussionsupporting

confidence: 89%

Risk factors for recurrence of deep infiltrating endometriosis after surgical treatment

Yela

Vitale

Vizotto

et al. 2021

J of Obstet and Gynaecol

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“…Several studies demonstrated the efficacy of bowel surgery for endometriosis on the basis of a low rate of symptomatic and anatomic recurrence [17]. However, colorectal surgery for RSE is associated with a significant morbidity, eventually requiring additional interventional procedures and drastically reducing the quality of life of the affected patients [18].…”

Section: Discussionmentioning

confidence: 99%

Indocyanine Green Fluorescence Angiography after Full-thickness Bowel Resection for Rectosigmoid Endometriosis–A Feasibility Study

Raimondo

Maletta

Borghese

et al. 2021

Journal of Minimally Invasive Gynecology

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To evaluate feasibility of near-infrared (NIR)−indocyanine green (ICG) imaging for bowel vascularization assessment after full-thickness bowel resection for rectosigmoid endometriosis (RSE). Design: This is a prospective, single-center, preliminary study on consecutive patients who were symptomatic submitted to discoid or segmental resection for RSE and NIR-ICG evaluation for vascular assessment of the anastomotic line from May 2018 to January 2020. Setting: Tertiary university hospital. Patients: Thirty-two women with RSE meeting eligibility criteria were included for study analysis. Interventions: NIR-ICG evaluation of anastomotic line vascularization after RSE removal. Measurements and Main Results: Fluorescence degree of the anastomotic line was assessed with a 0 to 2 Likert scale, as follows: 0 or "absent" (no fluorescence observed), 1 or "irregular" (not uniform distribution or weak fluorescence), and 2 or "regular" (uniform distribution of fluorescence and similar to the proximal colon). In all the patients included in the study (100%), NIR-ICG imaging allowed the evaluation of fluorescence degree of the anastomotic line. No adverse reaction related to ICG use was recorded. The protocol did not greatly lengthen operating time (median, 4 [range, 3−5] minutes). Excellent interoperator agreement was observed. Most of the patients (31 of 32, 96.9%) showed regular fluorescence on the anastomotic line; in 1 patient with irregular fluorescence at NIR-ICG after discoid excision, the anastomotic suture was reinforced through interrupted stitches. We had 1 case of anastomotic leakage after segmental resection with intraoperative good fluorescence at NIR-ICG evaluation. Conclusion: NIR-ICG imaging for anastomotic perfusion assessment after discoid or segmental resection for RSE seems to be a feasible, safe, and reproducible method.

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“…In comparison with segmental resection, superficial resection has the benefits of technical simplicity, shorter operative times, lower complication rates, shorter hospitalization times, and better functional results in terms of continence and constipation (37) . The main disadvantage of the technique, as reported in a recent systematic revision and meta-analysis, is an increased recurrence rate in comparison with segmental resection (chance rate [OR] 5.53; P=0.001) and with discoid resection (OR 3.83, P=0.01) (45) .…”

Section: Superficial Resection (Shaving)mentioning

confidence: 99%

“…A recent systematic review about histology-verified recurrence at least 12 months after intestinal endometriosis surgery covered 41 studies and selected four for the meta-analysis. According to the authors, the risk of recurrence was significantly lower in segmental or discoid resection when compared to superficial resection (45) . Histopathologic findings, such as the presence of satellite lesions, marginal positivity, and thickness of infiltration, seem to have no relation to recurrence rates or to impact on quality of life (62) .…”

mentioning

confidence: 99%

“…Since segmental resection is associated to higher rates of complete resection and lower recurrence, there is doubt in the literature about the inferiority of intestinal or urinary functional results, compared to techniques that preserve the rectum (37,45) . Roman et al conducted a randomized study to compare conservative techniques with colorectal resection in 60 patients who presented with lesions varying between 25 and 40 mm, infiltrating the muscle layer, and with 50% of the rectal circumference compromised.…”

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confidence: 99%

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Surgical Techniques for the Treatment of Rectal Endometriosis: A Systematic Review of Randomized Controlled Trials and Observational Studies

Popoutchi

Marques

Averbach

et al. 2021

Arq. Gastroenterol.

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BACKGROUND Endometriosis is a common disease in reproductive-age women and it is estimated to occur in up to 50% of those with infertility. Intestinal involvement is reported in up to a third of the cases. This condition is related to chronic pain and loss of quality of life, resulting in emotional, social and economic costs. Treatment consists of hormonal block and surgical resection, with variable side effects and efficacy. The best choice for surgical treatment for rectal endometriosis is a matter of discussion regarding the indication and the best technique to be employed. OBJECTIVE To summarize data on indications, results and complications of surgical techniques for the treatment of rectal endometriosis. METHODS: This comprehensive systematic review is a compilation of the available literature and discussion, carried out by a team with experience in the surgical treatment of intestinal endometriosis. Data regarding indications, results and complications of conservative and radical techniques for the surgical treatment of rectal endometriosis was carefully reviewed. Searches of PubMed, EMBASE, and CENTRAL up to May 2021 were performed to identify randomized controlled trials (RCTs) and observational studies that compared at least two of the three surgical techniques of interest (i.e., shaving, discoid resection, segmental resection). RESULTS: One RCT and nine case series studies with a total of 3,327 patients met the eligibility criteria. Participants ages ranged from a mean of 30.0 to 37.9 years old. Mean follow-up ranged from 1.2 to 42.76 months. With regards the methodological quality, overall the included studies presented a low risk of bias in the majority of the domains. Surgical treatment of rectal endometriosis is indicated for patients with obstructive symptoms and those with pain scores above 7/10. Patients with disease involving beyond muscularis propria of the rectum, documented in magnetic resonance imaging or transvaginal pelvic ultrasound with intestinal preparation, are candidates for discoid or segmental resection. The presence of multifocal disease, extension greater than 3 cm and infiltration greater than 50% of the loop circumference favor the radical technique. The distance from the lesion to the anal verge, age, symptoms and reproductive desire are other factors that influence the choice of the technique to be employed. The risk of complications and unfavorable functional results seems to be directly related to the complexity of the procedure. CONCLUSION: The choice of surgical technique performed for the treatment of rectal endometriosis is a matter of discussion and depends not only on the preoperative staging, but also on the patient’s expectations, risks and potential complications, recurrence rates and the expertise of the multidisciplinary team.

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

Cited by 32 publications

References 60 publications

Risk factors for recurrence of deep infiltrating endometriosis after surgical treatment

Risk factors for recurrence of deep infiltrating endometriosis after surgical treatment

Indocyanine Green Fluorescence Angiography after Full-thickness Bowel Resection for Rectosigmoid Endometriosis–A Feasibility Study

Surgical Techniques for the Treatment of Rectal Endometriosis: A Systematic Review of Randomized Controlled Trials and Observational Studies

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