Ovarian endometriosis: what are the risk factors for postop recurrence?

Takeaway

• Dysmenorrhoea severity and postoperative pregnancy are independent risk factors for the recurrence of endometrioma and endometriosis-related pain recurrence after surgery.

Why this matters

• Endometrioma recurrence is one of the most important issues in the management of endometriosis.
• Findings highlight that more attention should be paid to the risk for endometrioma and endometriosis-related pain in patients who have serious dysmenorrhoea and individualised management should be applied to achieve better efficacy.

Study design

• Retrospective study of 358 women (mean age, 33.2±5.4 years; body mass index (BMI): 21.2±2.6 kg/m²) with endometriomas who had minimum of 5 years of postoperative follow-up after undergoing laparoscopic cystectomy during 2009-2013 was conducted.
• All women were categorised into recurrence group and non-recurrence group.
• Funding: National Key R&D Program of China and others.

Key results

• Cumulative incidence rates of recurrence at 5-10 years after surgery were 15.4%, 16.8%, 19.3%, 22.5%, 22.5% and 22.5%, respectively.
• Differences were found between 2 groups in terms of:
  • age at surgery (risk ratio [RR], 0.764; 95% CI, 0.615-0.949; P=.015),
  • duration of dysmenorrhoea (RR, 1.120; 95% CI, 1.054-1.190; P<.001),
  • the presence of adenomyosis (RR, 1.629; 95% CI, 1.008-2.630; P=.046) and
  • CA125 level (RR, 1.856; 95% CI, 1.072-3.214; P=.021).
• In multivariate analysis, extent of dysmenorrhoea (RR, 1.711; 95% CI, 1.175-2.493; P=.005) and postoperative pregnancy (RR, 0.649; 95% CI, 0.460-0.914; P=.013) significantly correlated with endometrioma and endometriosis-related pain recurrence.
• Gravida, parity, BMI, infertility, leiomyoma presence, size of ovarian endometrioma, the presence of deep infiltrating endometriosis and disease stage or postoperative medication showed no significant association with recurrence rate.

Limitations

• Retrospective design.
• Single-centre study.