Recurrence in Deep Infiltrating Endometriosis: A Systematic Review of the Literature

Ianieri, Manuel Maria; Mautone, Daniele; Ceccaroni, Marcello

doi:10.1016/j.jmig.2017.12.025

Cited by 56 publications

(48 citation statements)

References 59 publications

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“…It is unclear whether endometriosis is a recurrent disease (59). Studies generally describe recurrence of symptoms instead of recurrence of lesions (60). Recurrence rates of cystic ovarian endometriosis after stripping are less than 20% within 6 months (61, 62) but vary with the surgeon (63) and the technique used.…”

Section: Observations In Endometriosismentioning

confidence: 99%

Pathogenesis of endometriosis: the genetic/epigenetic theory

Koninckx

Ussia

Adamyan

et al. 2019

Fertility and Sterility

294

187

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Objective: To study the pathophysiology of endometriosis. Design: Overview of observations on endometriosis. Setting: Not applicable. Patient(s): None. Interventions(s): None. Main Outcome Measure(s): The hypothesis is compatible with all observations. Result(s): Endometriosis, endometrium-like tissue outside the uterus, has a variable macroscopic appearance and a poorly understood natural history. It is a hereditary and heterogeneous disease with many biochemical changes in the lesions, which are clonal in origin. It is associated with pain, infertility, adenomyosis, and changes in the junctional zone, placentation, immunology, plasma, peritoneal fluid, and chronic inflammation of the peritoneal cavity. The Sampson hypothesis of implanted endometrial cells following retrograde menstruation, angiogenic spread, lymphogenic spread, or the metaplasia theory cannot explain all observations if metaplasia is defined as cells with reversible changes and an abnormal behavior/morphology due to the abnormal environment. We propose a polygenetic/polyepigenetic mechanism. The set of genetic and epigenetic incidents transmitted at birth could explain the hereditary aspects, the predisposition, and the endometriosis-associated changes in the endometrium, immunology, and placentation. To develop typical, cystic ovarian or deep endometriosis lesions, a variable series of additional transmissible genetic and epigenetic incidents are required to occur in a cell which may vary from endometrial to stem cells. Subtle lesions are viewed as endometrium in a different environment until additional incidents occur. Typical cystic ovarian or deep endometriosis lesions are heterogeneous and represent three different diseases. Conclusion(s): The genetic epigenetic theory is compatible with all observations on endometriosis. Implications for treatment and prevention are discussed. (Fertil Steril Ò 2019;111:327-40. Ó2018 by American Society for Reproductive Medicine.) El resumen está disponible en Español al final del artículo.

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Section: Observations In Endometriosismentioning

confidence: 99%

Pathogenesis of endometriosis: the genetic/epigenetic theory

Koninckx

Ussia

Adamyan

et al. 2019

Fertility and Sterility

294

187

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“…A recurrence that led to repeated surgery developed in 21.8% of patients in our sturdy population. This value falls into the lower range of data published in the literature, where a recurrence rate of between 18.9 and 57% after 5 years is specified [ 18 – 20 , 22 , 38 – 40 ]. It should be kept in mind that in some of our patients, 14 years had passed since surgery.…”

Section: Discussionmentioning

confidence: 84%

Reproductive capacity and recurrence of disease after surgery for moderate and severe endometriosis – a retrospective single center analysis

et al. 2020

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Background Endometriosis can be associated with considerable pain and sterility. After surgical excision of moderate or severe endometriosis lesions, the rate of recurrence reaches up to 67%. The objective of this retrospective study was to establish the recurrence and pregnancy rates following surgical resection of stage III/IV endometriosis lesions. Indications for operation were endometriosis symptoms, sonographic findings and/or infertility. Methods A total of 456 patients who underwent stage III/IV endometriosis surgery between 2004 and 2014 were sent a questionnaire relating to their postoperative medical treatment, pregnancies, relief of symptoms and recurrence. Responses of 206 patients (45.2%) and their clinical data were analysed for this study. Results A total of 66.5% ( N = 137) of patients had stage III disease, and 33.5% ( N = 69) had stage IV disease. The average age was 37 years (17–59). A total of 63.1% ( N = 130) of surgeries were performed by laparoscopy, 21.8% ( N = 45) were performed by laparotomy and 15% ( N = 31) were performed by conversion. Complete resection of endometriosis lesions was achieved in 90.8% of patients ( N = 187). After surgery, 48.5% ( N = 100) of the women did not receive hormonal treatment; the main reason was the desire for children in 53%. Complete or partial relief in complaints was achieved in 93.2% ( N = 192). The rate of recurrence was 21.8% ( N = 45). The statistically significant factors that was associated with a higher risk to develop recurrence was an age < 35 ( p < 0.005). After surgery, 65.8% (79/120) of patients who wished to have children became pregnant. There was a statistically significant association among a higher postoperative pregnancy rate and age < 35 ( p < 0.003) in multivariate logistic regression analysis and laparoscopic surgical access in univariate logistic regression analysis ( p < 0.01). Conclusion We assessed the high percentage of complete or partial relief of symptoms of 93.2%, the high postoperative pregnancy rate of 65.8% and the low rate of recurrence of 21.8% compared to international literature to be very encouraging for women suffering from moderate and severe endometriosis. Though laparoscopy is considered the ‘gold standard’of endometriosis surgery, laparotomy still may be indicated in patients with extensive endometriosis especially to preserve reproductive function.

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“…Ford et al [31] and Garry et al [32] showed that radical endometriosis lesions resection can help clearly relieve symptoms and improve the quality of life. However, in the case of extensive excision, the risk of damage to the urinary and intestinal tract with respective late damage must be noted [30,33,34]. In our cohort, 8.3% of patients (17/206) required a procedure for intestinal or bladder surgery due to deep infiltrating endometriosis.…”

Section: Stage-related Surgical Procedures and Postoperative Rate Of mentioning

confidence: 78%

Reproductive capacity and recurrence of disease after surgery for moderate and severe endometriosis.

Schippert

Witte

Bartels

et al. 2020

Preprint

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Background Endometriosis can be associated with considerable pain and sterility. After surgical excision of moderate or severe endometriosis the recurrence rates amount to 50%. The objective of this retrospective study was to evaluate the recurrence and pregnancy rates following surgical resection of endometriosis stage III/IV. Methods 456 patients who underwent stage III/IV endometriosis surgery between 2004 and 2014 were sent a questionnaire relating to postoperative medical treatment, pregnancies, relief of symptoms and recurrence. Data and responses of 206 patients (45.2%) were analyzed. The statistical analysis was performed with the statistical software ´R`. Statistical significance was given if the p-value was less than 0.05. The study was approved by the local Ethics Committee of Hannover Medical School. Results 66.5% (N=137) of patients were established with stage III, 33.5% (N=69) with stage IV. Average age was 37 years (17-59). 63.1% (N=130) of surgeries were performed by laparoscopy with an average duration of 81 minutes, 21.8% (N=45; 189 minutes) by laparotomy and 15% (N=31; 202 minutes) by conversion. Complete resection of endometriosis was achieved in 90.8% (N=187). After surgery, 48.5% (N=100) of the women did not receive hormonal treatment, main reason was the desire for children in 53%. Complete or partial relief in complaints was achieved in 93.2% (N=192). Rate of recurrence was 21.8% (N=45). The association between incomplete resection and recurrence was on the threshold of significance (p=0.1). After surgery, 65.8% (79/120) of patients who wished to have children got pregnant. There is a statistically significant association between postoperative pregnancy rate and age <35 (p<0.002) and laparoscopic surgical access (p<0.01). Conclusion We assess the high percentage of complete or partial reduction of symptoms of 93.2%, the high postoperative pregnancy rate of 65.8% and the low rate of recurrence of 21.8% compared to international literature to be very encouraging for women suffering from moderate and severe endometriosis. Though laparoscopy is considered as ´gold standard` of endometriosis surgery, laparotomy still may be indicated in cases of extended endometriosis especially to preserve reproductive function.

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Recurrence in Deep Infiltrating Endometriosis: A Systematic Review of the Literature

Cited by 56 publications

References 59 publications

Pathogenesis of endometriosis: the genetic/epigenetic theory

Pathogenesis of endometriosis: the genetic/epigenetic theory

Reproductive capacity and recurrence of disease after surgery for moderate and severe endometriosis – a retrospective single center analysis

Reproductive capacity and recurrence of disease after surgery for moderate and severe endometriosis.

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