Recurrence of ovarian endometrioma after laparoscopic excision: Risk factors and prevention

Ouchi, Noriaki; Akira, Shigeo; Mine, Katsuya; Ichikawa, Masao; Takeshita, Toshiyuki

doi:10.1111/jog.12164

Cited by 45 publications

(41 citation statements)

References 33 publications

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Section: Discussionunclassified

“…Seu emprego se justifica pela indução da apoptose, redução da proliferação endometrial e inibição da ovulação, o que diminui a dor relatada 23,27 e o desenvolvimento dos endometriomas ovarianos 5 . O efeito oposto é observado nas pacientes que optam pela descontinuidade, mesmo que transitória, do método hormonal supressor da ovulação utilizado 5,16 . Um estudo de coorte retrospectivo envolvendo 87 pacientes com endometrioma reportou menor taxa de recidiva entre as que usaram contracepção oral contínua no pós-operatório, com taxas ainda menores naquelas que mantiveram seu uso por mais de 24 meses, quando comparadas àquelas que interromperam seu uso no fim do seguimento ou àquelas que nunca usaram.…”

Section: Discussionunclassified

“…O endometrioma ovariano é a lesão mais frequente, incidindo, em média, em 55% das pacientes portadoras dessa afecção 3 . A videolaparoscopia com exérese da cápsula do cisto endometriótico é o tratamento mais frequentemente realizado, com evidências na literatura de que possa resultar em menor taxa de recorrência da lesão [4][5][6] , quando comparada à fenestração ou drenagem do cisto [7][8][9] . Uma metanálise de sete ensaios clínicos randomizados demonstra que a exé-rese da cápsula foi associada ao menor risco de recorrência dos sintomas, com odds ratio (OR) de 0,2 e menor risco de recidiva do endometrioma (OR=0,5) após a cirurgia quando comparada à fenestração/coagulação 10 .…”

Section: Introductionunclassified

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Fatores preditores de recorrência do endometrioma ovariano após tratamento laparoscópico

Carvalho

Pereira

Martins

et al. 2015

Rev. Bras. Ginecol. Obstet.

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ResumoOBJETIVO: Analisar os fatores que possam influenciar na recorrência do endometrioma ovariano após tratamento videolaparoscópico. MÉTODOS: Estudo de coorte retrospectivo. Foram avaliadas 129 pacientes submetidas à videolaparoscopia, entre 2003 e 2012, para tratamento de endometrioma ovariano, com seguimento pós-operatório mínimo de 2 anos. Foi realizada ultrassonografia transvaginal para excluir persistência da lesão e identificação de recidiva. Para comparação de variáveis contínuas foi utilizado o teste t de Student, e para o teste de homogeneidade entre as proporções, o teste do χ 2 ou exato de Fisher (para frequências menores do que cinco). Para a obtenção de fatores prognósticos ligados à recidiva foi aplicado o modelo de regressão linear multivariado. O nível de significância utilizado para a análise foi de 5%. RESULTADOS: A taxa de recorrência foi de 18.6%. O tamanho do endometrioma, a modalidade cirúrgica empregada e os dados demográficos como idade, índice de massa corpórea, presença de sintomas, tabagismo e prática de exercícios físicos não se associaram ao aumento da recorrência. Foi observado que a interrupção do tratamento clínico pós-operatório apresentou risco significativo para aumento da recorrência (OR 23,7; IC95% 5,05; p=0,001). CONCLUSÃO: O uso contínuo de contracepção oral parece reduzir dramaticamente a taxa de recidiva de endometrioma ovariano. Neste estudo, a interrupção do tratamento foi o fator associado com maior taxa de recidiva da lesão após o tratamento videolaparoscópico. Abstract PURPOSE:To analyze the factors that might influence the recurrence of ovarian endometriomas after laparoscopic excision. METHODS: A retrospective cohort study. We evaluated 129 patients who underwent laparoscopic excision of ovarian endometriomas from 2003 to 2012 and who were followed up for at least two years after surgery. Vaginal ultrasound was repeated to exclude persistent lesion and to identify recurrence. The Student's t-test was used to compare continuous variables and the χ 2 or Fischer exact test (for values of less than five) was used to test homogeneity between proportions. A logistic regression model for multivariate proportional hazards was used to analyze predictors of long-term outcome. The level of significance was set at 5% in all analyses. RESULTS: The overall rate of ovarian endometrioma recurrence was 18.6%. Endometrioma diameter, surgical procedure techniques and demographic data such as age, presenting symptoms, body mass index, smoking and physical exercise habits were not associated with recurrence, whereas interruption of postoperative medical treatment was significantly correlated with a higher recurrence rate (OR 23.7; p=0.001). CONCLUSION: Current oral contraceptive use appears to be associated with a dramatic reduction in the risk of recurrence of ovarian endometriotic cysts. Treatment interruption was associated with a higher recurrence rate of ovarian endometrioma after laparoscopic treatment.

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Section: Discussionunclassified

Section: Introductionunclassified

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Fatores preditores de recorrência do endometrioma ovariano após tratamento laparoscópico

Carvalho

Pereira

Martins

et al. 2015

Rev. Bras. Ginecol. Obstet.

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“…Patients who received GnRHa for 6 months post-operatively are reported to have a recurrence rate of 5.3% at 24 months [2]; in contrast, others have reported that GnRHa has no effect on recurrence [19][20][21]. The recurrence rates at 36 months post-operatively, in patients taking OC after surgery, were 49% in those that took the OC for less than 1 year, 22% for those that continued treatment for 1 year or more (mean, 20 months), and 6% for those that continued to use the medication [1]; there are fears that longterm treatment with the OC may cause serious adverse events, including deep vein thrombosis [22].…”

Section: Discussionmentioning

confidence: 90%

“…Few studies have discussed the recurrence of cysts in patients treated with dienogest. However, a previous study with a small number of subjects (n ¼ 7) reported on the effectiveness of dienogest; no patients had recurrence during a period of continuous administration of dienogest (2 mg/day) for 13 months post-operatively [19], suggesting its potential effectiveness. However, this study did not evaluate the recurrence rate after the completion of treatment.…”

Section: Discussionmentioning

confidence: 96%

Outcomes of treatment with cyclic administration of dienogest after ovarian endometriotic cystectomy

Yanase

Ishida

Nishijima

et al. 2015

Gynecological Endocrinology

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To evaluate the outcomes of patients treated with cyclic administration of dienogest after ovarian endometriotic cystectomy, following the completion of treatment. We retrospectively evaluated 26 patients treated with dienogest (2 mg/day) after cystectomy (revised American Society for Reproductive Medicine [r-ASRM] stage III-IV) in a pilot study. Dienogest was administered cyclically, for a total of six cycles, each comprising three weeks on and one week off. Outcomes of interest included severity of menstrual pain and recurrence of cysts at baseline, during the immediate post-treatment period and at the final outpatient follow-up. The mean outpatient follow-up period was 45.0 months. The visual analog scale score for menstrual pain following 6 cycles of dienogest treatment was significantly lower than that at baseline; it remained low at the final follow-up. The recurrence rates of cysts were 4% and 21% at 24 and 48 months after the completion of dienogest treatment, respectively. Six patients with recurrent disease were all classified as having r-ASRM stage IV. Our results suggest that cyclic dienogest for six months after cystectomy could relieve menstrual pain and reduce the recurrence of cysts, for approximately four years. The necessary treatment period for patients with r-ASRM stage IV disease requires further study.

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Age at surgery and recurrence of ovarian endometrioma after conservative surgery: a meta-analysis including 3125 patients

Yang

Liu

Lin

et al. 2020

Arch Gynecol Obstet

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Purpose To evaluate the association between age at surgery and recurrence rate of endometrioma. Data sources PubMed, Embase, and the Cochrane Library were searched up to October 2019. Methods We determined the pooled relative risk (RR) and 95% confidence intervals (CIs) to assess the relationship between age at surgery and the recurrence rate of endometrioma after surgery. Begg’s funnel plot and Egger’s linear regression was used to assess any publication bias. Results A total of 3125 patients from 10 studies were finally enrolled in this meta-analysis. The recurrence rate decreased with increasing age (RR = 0.93, 95% CI = 0.91–0.95, P = 0.451). Subgroup analysis demonstrated that the pooled RR was 0.926 (95% CI 0.906–0.947, P < 0.001) for a cut-off < 35, and 0.886 (95% CI 0.775–1.040, P = 0.14) for a cut-off ≥ 35. Begg’s funnel plot and Egger’s linear regression test showed no evidence of publication bias. Conclusion This meta-analysis suggested that younger age might be a high-risk factor for the recurrence of ovarian endometrioma after conservative surgery.

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Recurrence of ovarian endometrioma after laparoscopic excision: Risk factors and prevention

Cited by 45 publications

References 33 publications

Fatores preditores de recorrência do endometrioma ovariano após tratamento laparoscópico

Fatores preditores de recorrência do endometrioma ovariano após tratamento laparoscópico

Outcomes of treatment with cyclic administration of dienogest after ovarian endometriotic cystectomy

Age at surgery and recurrence of ovarian endometrioma after conservative surgery: a meta-analysis including 3125 patients

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