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Development of ovarian cancer after excision of endometrioma. Fertil Steril 2016; 106:1432-1437.e2. [DOI: 10.1016/j.fertnstert.2016.07.1077] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 07/07/2016] [Accepted: 07/14/2016] [Indexed: 11/19/2022]
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Tobiume T, Kotani Y, Takaya H, Nakai H, Tsuji I, Suzuki A, Mandai M. Determinant factors of postoperative recurrence of endometriosis: difference between endometrioma and pain. Eur J Obstet Gynecol Reprod Biol 2016; 205:54-9. [PMID: 27566223 DOI: 10.1016/j.ejogrb.2016.07.516] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 06/21/2016] [Accepted: 07/27/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Although the postoperative use of hormonal treatment for endometriosis is recommended in the European Society of Human Reproduction and Embryology guidelines to prevent the recurrence of endometriosis-associated dysmenorrhoea, hormonal treatment may not be necessary for all patients who undergo surgical treatment for endometriosis. The aim of this study was to clarify the determinant factors that predict the recurrence of endometriosis after surgery in order to develop personalized hormonal treatment recommendations. Factors associated with the recurrence of endometrioma and pain were investigated independently to identify the likelihood of recurrence in each individual patient. STUDY DESIGN Between 2008 and 2013, 352 patients underwent surgery and were diagnosed with endometriosis based on pathological findings at the study hospital. Among these patients, 191 experienced a recurrence of endometrioma in the absence of pre- or postoperative hormonal treatment. Various clinical factors such as pre-operative pain, intra-operative findings and postoperative improvement of pain were compared between patients who experienced recurrence after surgery and those who did not. RESULTS The cumulative 5-year recurrence rate of endometrioma was 28.7% among the 191 patients who did not undergo pre- or postoperative hormonal treatment. Significant differences were detected in maximum tumour diameter, revised American Society for Reproductive Medicine score (r-ASRM score), operative time and operative blood loss between patients in the recurrent endometrioma group and the non-recurrent endometrioma group; only the r-ASRM score was significantly correlated with recurrence of endometrioma in the multivariate analysis. The cumulative 5-year rate of persistent/recurrent pain was 33.4%. There were significant differences in the postoperative improvement of pain between the persistent/recurrent pain group and the non-recurrent pain group according to the univariate and multivariate analyses. CONCLUSION This study suggests that the risk factors for recurrence of endometrioma differ from the risk factors for recurrence of pain. The use of postoperative hormonal treatment should be considered based on the dominant risk factors and needs of each patient.
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Affiliation(s)
- T Tobiume
- Department of Obstetrics and Gynaecology, Kinki University Faculty of Medicine, Osaka, Japan.
| | - Y Kotani
- Department of Obstetrics and Gynaecology, Kinki University Faculty of Medicine, Osaka, Japan
| | - H Takaya
- Department of Obstetrics and Gynaecology, Kinki University Faculty of Medicine, Osaka, Japan
| | - H Nakai
- Department of Obstetrics and Gynaecology, Kinki University Faculty of Medicine, Osaka, Japan
| | - I Tsuji
- Department of Obstetrics and Gynaecology, Kinki University Faculty of Medicine, Osaka, Japan
| | - A Suzuki
- Department of Obstetrics and Gynaecology, Kinki University Faculty of Medicine, Osaka, Japan
| | - M Mandai
- Department of Obstetrics and Gynaecology, Kinki University Faculty of Medicine, Osaka, Japan.
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Adachi K, Takahashi K, Nakamura K, Otake A, Sasamoto N, Miyoshi Y, Shioji M, Yamamoto Y, Fujitani M, Wakimoto A, Tokuhira A, Kobayashi E, Yoshimura A, Sawada K, Kimura T. Postoperative administration of dienogest for suppressing recurrence of disease and relieving pain in subjects with ovarian endometriomas. Gynecol Endocrinol 2016; 32:646-649. [PMID: 26890948 DOI: 10.3109/09513590.2016.1147547] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
To assess the effect of dienogest on recurrence of ovarian endometriomas and severity of pain after laparoscopic surgery, a retrospective study of 81 patients was performed at three institutions in Osaka, Japan. Patients had a six-month minimum follow-up after laparoscopic surgery for ovarian endometriomas performed between June 2012 and August 2014. Patients who chose to receive 2 mg dienogest daily and those who were managed expectantly postoperatively were included. Recurrence was defined as the presence of endometriomas of more than 2 cm. A visual analog scale (VAS) was used to score the intensity of pelvic pain. The cumulative recurrence rate and absolute VAS score changes between the baseline and at 6, 12, 18 and 24 months after the start of administration were evaluated in both groups. The recurrence rate was 16.5% and 24.0% in the expectant management group at 12 and 24 months, respectively. No recurrences occurred in the dienogest treatment group. The rate of VAS score reduction was significantly higher in the dienogest than in the expectant management group. Dienogest is effective on the recurrence of ovarian endometrioma and relieving pelvic pain after laparoscopic surgery.
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Affiliation(s)
- Kazushige Adachi
- a Department of Obstetrics and Gynecology , Minoh City Hospital , Osaka , Japan
| | - Kayo Takahashi
- a Department of Obstetrics and Gynecology , Minoh City Hospital , Osaka , Japan
| | - Koji Nakamura
- b Department of Obstetrics and Gynecology , Osaka University Graduate School of Medicine , Osaka , Japan , and
| | - Akiko Otake
- a Department of Obstetrics and Gynecology , Minoh City Hospital , Osaka , Japan
| | - Naoko Sasamoto
- a Department of Obstetrics and Gynecology , Minoh City Hospital , Osaka , Japan
| | - Yukari Miyoshi
- a Department of Obstetrics and Gynecology , Minoh City Hospital , Osaka , Japan
| | - Mitsunori Shioji
- a Department of Obstetrics and Gynecology , Minoh City Hospital , Osaka , Japan
| | - Yoshimitsu Yamamoto
- a Department of Obstetrics and Gynecology , Minoh City Hospital , Osaka , Japan
| | - Mayumi Fujitani
- c Department of Obstetrics and Gynecology , Toyonaka City Hospital , Osaka , Japan
| | - Akinori Wakimoto
- c Department of Obstetrics and Gynecology , Toyonaka City Hospital , Osaka , Japan
| | - Atsushi Tokuhira
- c Department of Obstetrics and Gynecology , Toyonaka City Hospital , Osaka , Japan
| | - Eiji Kobayashi
- b Department of Obstetrics and Gynecology , Osaka University Graduate School of Medicine , Osaka , Japan , and
| | - Akihiko Yoshimura
- b Department of Obstetrics and Gynecology , Osaka University Graduate School of Medicine , Osaka , Japan , and
| | - Kenjiro Sawada
- b Department of Obstetrics and Gynecology , Osaka University Graduate School of Medicine , Osaka , Japan , and
| | - Tadashi Kimura
- b Department of Obstetrics and Gynecology , Osaka University Graduate School of Medicine , Osaka , Japan , and
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Preoperative risk factors in recurrent endometrioma after primary conservative surgery. Obstet Gynecol Sci 2016; 59:286-94. [PMID: 27462595 PMCID: PMC4958674 DOI: 10.5468/ogs.2016.59.4.286] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 12/21/2015] [Accepted: 12/23/2015] [Indexed: 11/13/2022] Open
Abstract
Objective Endometriosis is a common gynecological disorder caused by ectopic implantation of endometrial glandular and stromal cells outside the uterine cavity. Among several types of endometriosis, endometrioma is the only subtype that could be determined preoperatively using pelvic ultrasonography, and guidelines recommend pathologic confirmation of endometrioma greater than 3 cm in diameter. However, although surgery is performed in cases of endometrioma, endometrioma has a high cumulative rate of recurrence. Therefore, because determining the possibility of recurrence before performance of initial surgery is important, we examined preoperative factors associated with recurrent endometrioma. Methods This was a retrospective, comparative study including 236 patients who visited the outpatient clinic between January 2009 and December 2011. Patients who were pathologically diagnosed with endometrioma were included in this study. They were followed up postoperatively and were divided into two groups according to presence of recurrent endometrioma. Results We examined associations between baseline factors and recurrent endometrioma. In multivariate analysis, dysmenorrhea and cyst septation were statistically significant after adjusting with age, parity, surgical staging and postoperative management. We examined cumulative recurrence free survival within cases of recurrent endometriosis, based on the presence of inner cyst septation. The cumulative recurrence free survival was lower in cases with septation. Conclusion Our study found that recurrent endometrioma is more likely in patients with inner cyst septation and the recurrence occurred within a shorter duration of time than in patients without inner cyst septation on preoperative ultrasonography. Therefore intensive caution and postoperative long term medical therapy would be appropriate in patients with inner cyst septation on preoperative ultrasonography before undergoing primary surgery for endometrioma.
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Selcuk S, Cam C, Koc N, Kucukbas M, Ozkaya E, Eser A, Karateke A. Evaluation of risk factors for the recurrence of ovarian endometriomas. Eur J Obstet Gynecol Reprod Biol 2016; 203:56-60. [PMID: 27240262 DOI: 10.1016/j.ejogrb.2016.05.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 05/07/2016] [Accepted: 05/13/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To evaluate the risk factors for the recurrence of ovarian endometrioma after laparoscopic cystectomy. STUDY DESIGN Reproductive aged patients who underwent laparoscopic ovarian endometriotic cystectomy and with histopathologically confirmed diagnosis of ovarian endometrioma were evaluated retrospectively. Histopathologic specimens were reevaluated and histopathologic characteristics of ovarian endometriotic cysts (thickness of cyst wall, thickness of fibrosis [ToF], thickness of ovarian tissue, the number of follicles per cyst, the depth of penetration [DoP] of endometrial tissue into the cyst wall) were determined. Along the determined histopathologic findings, demographic characteristics (age at surgery, number of pregnancies), clinical symptoms (dysmenorrhea, infertility), intraoperative findings (revised American Society for Reproductive Medicine [rASRM] stage), imaging features (bilaterality, cyst diameter), and biochemical parameters (Ca125, Ca19.9, Ca15.3) were evaluated as possible risk factors for the recurrence of endometrioma. The variables with p<0.2 in univariate analysis were introduced into regression analysis to determine the risk factors for recurrence. RESULTS There were statistically significant differences in age group (≤35 years and >35 years), the ToF and DoP between patients with recurrence and those with no recurrence. In Cox regression analysis, age ≤35 years and DoP were significant risk factors for presence of recurrence. DoP, ToF, preoperative cyst diameters in ultrasonographic examination were inversely correlated with recurrence interval. In multivariate regression analysis, the DoP was found the only significant risk factor for the recurrence interval. 1.2mm of DoP was found as the optimum cut off value for presence of recurrence according to Youden index criteria in ROC curve analyze. The sensitivity (62.9%), specificity (75%) were obtained at the cut off value of 1.2mm for DoP. CONCLUSION Histopathological features of ovarian endometriotic cyst may have important roles on predicting the recurrence of the endometrioma. Predicting the recurrence risk of particular patient is very important in future management of the disease. Knowing the recurrence risk of an endometrioma will help in deciding the optimal treatment modalities for each individual patient. High risk patients should be offered appropriate treatments according to the clinical status without delay and low risk patients should be protected from overtreatment.
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Affiliation(s)
- Selcuk Selcuk
- Zeynep Kamil Training and Researching Hospital, Department of Obstetrics and Gynecology, Opr. Dr. Burhanettin Ustunel St., No: 10, Uskudar/Istanbul, Turkey.
| | - Cetin Cam
- Zeynep Kamil Training and Researching Hospital, Department of Obstetrics and Gynecology, Opr. Dr. Burhanettin Ustunel St., No: 10, Uskudar/Istanbul, Turkey.
| | - Nermin Koc
- Zeynep Kamil Training and Researching Hospital, Department of Pathology, Opr. Dr. Burhanettin Ustunel St., No: 10, Uskudar/Istanbul, Turkey.
| | - Mehmet Kucukbas
- Zeynep Kamil Training and Researching Hospital, Department of Obstetrics and Gynecology, Opr. Dr. Burhanettin Ustunel St., No: 10, Uskudar/Istanbul, Turkey.
| | - Enis Ozkaya
- Zeynep Kamil Training and Researching Hospital, Department of Obstetrics and Gynecology, Opr. Dr. Burhanettin Ustunel St., No: 10, Uskudar/Istanbul, Turkey.
| | - Ahmet Eser
- Zeynep Kamil Training and Researching Hospital, Department of Obstetrics and Gynecology, Opr. Dr. Burhanettin Ustunel St., No: 10, Uskudar/Istanbul, Turkey.
| | - Ates Karateke
- Zeynep Kamil Training and Researching Hospital, Department of Obstetrics and Gynecology, Opr. Dr. Burhanettin Ustunel St., No: 10, Uskudar/Istanbul, Turkey.
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Santulli P, Lamau M, Marcellin L, Gayet V, Marzouk P, Borghese B, Lafay Pillet MC, Chapron C. Endometriosis-related infertility: ovarian endometriomaper seis not associated with presentation for infertility. Hum Reprod 2016; 31:1765-75. [DOI: 10.1093/humrep/dew093] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 03/23/2016] [Indexed: 11/14/2022] Open
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Xing W, Lin H, Wu Z, Li Y, Zhang Q. EFFECT OF PELVIC ENDOMETRIOSIS, ENDOMETRIOMAS AND RECURRENT ENDOMETRIOMAS ON IVF-ET/ICSI OUTCOMES. Mater Sociomed 2016; 28:91-4. [PMID: 27147911 PMCID: PMC4851495 DOI: 10.5455/msm.2016.28.91-94] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 03/12/2016] [Indexed: 11/13/2022] Open
Abstract
Introduction: Endometriosis, the most common gynecological disorder, is a challenging disease observed in 20% - 40% of subfertile women. Material and Methods: 380 women were divided into four groups. Group A consisted of 176 women with pelvic endometriosis. Group B consisted of 125 women who had previously undergone a laparoscopic endometrioma cystectomy. Group C consisted of 38 women with recurrent endometriomas without aspiration before IVF-ET/ICSI. Group D consisted of 41 women with recurrent endometriomas undergone aspiration before IVF-ET/ICSI. Results: Baseline FSH level (8.61 ± 3.42 mIU/mL) and total dose of Gn (2337.15 ± 853.00 IU) in Group A were the lowest (p < 0.05). The number of retrieved oocytes in Group B (7.98 ± 5.05) was significantly fewer than those in Group A and D (p < 0.05). The numbers of MII oocytes in Groups A, C and D were significantly larger than that in Group B. The number of retrieved oocytes, high-quality embryos, implantation and pregnancy rates were similar in Groups C and D. Conclusions: Pelvic endometriosis had a less adverse effect on ovarian reserve than endometrioma. No advantage was found in transvaginal aspiration for recurrent endometriomas before IVF-ET/ICSI.
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Affiliation(s)
- Weijie Xing
- Center for Reproductive Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Haiyan Lin
- Center for Reproductive Medicine, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zexuan Wu
- Center for Reproductive Medicine, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yu Li
- Center for Reproductive Medicine, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qingxue Zhang
- Center for Reproductive Medicine, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
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Seong SJ, Kim D, Lee KH, Kim TJ, Chung HH, Chang SJ, Lee EJ. Role of Hormone Therapy After Primary Surgery for Endometrioma: A Multicenter Retrospective Cohort Study. Reprod Sci 2016; 23:1011-8. [PMID: 26763524 DOI: 10.1177/1933719115625841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Endometriosis is a major cause of disability in women, and 40% to 50% of patients experience disease recurrence by 5 years after surgery. This multicenter retrospective cohort study (N = 588) determined the rate and risk factors for recurrent endometrioma after primary surgery and examined the role of postoperative hormone therapy. When recurrence was defined by sonographic identification of the endometrioma (≥20 mm in size), 61 (10.4%) patients experienced disease recurrence. The cumulative recurrence rates at 1, 2, 3, and 5 years after surgery were 2.2%, 4.9%, 6.9%, and 9.8%, respectively. To determine the risk factors for recurrence, the clinical factors of patients with and without recurrence were compared. There was a significantly increased risk of recurrence with posterior cul-de-sac (PCDS) obliteration (P = .031) and higher serum cancer antigen 125 (CA125) level (P = .005). A longer postoperative hormonal therapy duration (P < .01), absence of PCDS obliteration (P = .036), and lower serum CA125 level (P = .014) were associated with longer recurrence-free interval on multivariate analysis using the Cox regression model. Postoperative hormone therapy prolonged the interval from the time of surgery to the first recurrence. However, it did not prolong the interval from the end of treatment to the first recurrence. Our results indicate that although long-term postoperative hormone therapy might maintain minimal disease status, it does not control residual disease. Therefore, persistent hormone suppression should be used to prevent disease recurrence.
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Affiliation(s)
- Seok Ju Seong
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Daeyeon Kim
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Keun-Ho Lee
- Department of Obstetrics and Gynecology, The Catholic University, Seoul, Korea
| | - Tae-Joong Kim
- Department of Obstetrics and Gynecology, Sungkyunkwan University, Seoul, Korea
| | - Hyun Hoon Chung
- Department of Obstetrics and Gynecology, Seoul National University, Seoul, Korea
| | - Suk-Joon Chang
- Department of Obstetrics and Gynecology, Ajou University, Suwon, Korea
| | - Eun-Ju Lee
- Department of Obstetrics and Gynecology, Chung-Ang University Hospital, Chung-Ang University School of Medicine, Seoul, Korea
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Effect of second-line surgery on in vitro fertilization outcome in infertile women with ovarian endometrioma recurrence after primary conservative surgery for moderate to severe endometriosis. Obstet Gynecol Sci 2015; 58:481-6. [PMID: 26623412 PMCID: PMC4663226 DOI: 10.5468/ogs.2015.58.6.481] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 06/25/2015] [Accepted: 06/25/2015] [Indexed: 11/09/2022] Open
Abstract
Objective To evaluate the effect of second-line conservative surgery on in vitro fertilization (IVF) outcome in comparison with IVF without second-line surgery in infertile women with ovarian endometrioma recurrence after primary conservative surgery. Methods In this retrospective cohort study, 121 consecutive IVF/intracytoplasmic sperm injection cycles that were performed after second-line surgery (n=53) or without second-line surgery (control group, n=68) between January 2006 and December 2011 in 121 infertile women with ovarian endometrioma(s) recurrence after primary conservative surgery for moderate to severe endometriosis were included. The two groups were compared in terms of controlled ovarian stimulation and IVF outcomes. Results There were no differences in patients' characteristics between the two groups. Total dose and days of gonadotropins administered were significantly higher in the second-line surgery group than in the control group (P<0.001, P=0.008). The numbers of oocytes retrieved, mature oocytes and grade 1 or 2 embryos were significantly lower in the second-line surgery group (P=0.007, P=0.001, P<0.001, respectively). Clinical pregnancy rate per cycle and embryo implantation rate were also significantly lower in the second-line surgery group of 24.5% and 11.8% compared with 48.5% and 25.3% in the control group (P=0.008, P=0.005, respectively). Conclusion Ovarian response to controlled ovarian stimulation and IVF outcome after second-line surgery is worse than those
in IVF cycles without second-line surgery in infertile women with ovarian endometrioma recurrence after primary
surgery for moderate or severe endometriosis.
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Bozdag G. Recurrence of endometriosis: risk factors, mechanisms and biomarkers. ACTA ACUST UNITED AC 2015; 11:693-9. [PMID: 26439119 DOI: 10.2217/whe.15.56] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
While the incidence of endometriosis is up to 40-60% in women with severe dysmenorrhea/chronic pelvic pain, patients with subfertility carries a risk up to 20-30%. In symptomatic patients, although medical therapy is preferred in women with endometriosis, surgery might be needed in nonresponders or patients with an endometrioma. Following the surgery, recurrence of the disease and/or symptoms might be still noticed which will progressively increase as times goes by. Nevertheless, some risk factors have been identified for the risk of recurrence that decreases the success of the procedure. Those risk factors might be classified as patient-disease related and surgery-associated variables. Herein, we will address about the management of endometriosis regarding the risk factors for relapse, mechanisms of recurrence and potential biomarkers to predict the event.
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Affiliation(s)
- Gurkan Bozdag
- Department of Obstetrics & Gynaecology, School of Medicine, Hacettepe University, Ankara, Turkey
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Koga K, Takamura M, Fujii T, Osuga Y. Prevention of the recurrence of symptom and lesions after conservative surgery for endometriosis. Fertil Steril 2015; 104:793-801. [DOI: 10.1016/j.fertnstert.2015.08.026] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 08/20/2015] [Accepted: 08/24/2015] [Indexed: 01/02/2023]
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Park JY, Kim DY, Kim SH, Suh DS, Kim JH, Nam JH. Laparoendoscopic Single-site Compared With Conventional Laparoscopic Ovarian Cystectomy for Ovarian Endometrioma. J Minim Invasive Gynecol 2015; 22:813-9. [DOI: 10.1016/j.jmig.2015.03.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 03/14/2015] [Accepted: 03/17/2015] [Indexed: 10/23/2022]
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Ethanol sclerotherapy of ovarian endometrioma: a safe and effective minimal invasive procedure. Preliminary results. Eur J Obstet Gynecol Reprod Biol 2015; 187:25-9. [DOI: 10.1016/j.ejogrb.2015.02.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 01/29/2015] [Accepted: 02/06/2015] [Indexed: 11/20/2022]
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Jovanovic AM, Dikic SD, Janković-Raznatovic S, Savija J, Radaković J. The Importance of the Surgical Approach in the Prevention of Recurrence of Endometriosis. J Gynecol Surg 2015. [DOI: 10.1089/gyn.2014.0090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ana Mitrovic Jovanovic
- Department of Obstetrics and Gynecology, University Clinic of Gynecology and Obstetrics of “Narodni Front,” Beograd, Serbia, and Medical School University of Belgrade, Serbia
| | - Svetlana Dragojevic Dikic
- Department of Obstetrics and Gynecology, University Clinic of Gynecology and Obstetrics of “Narodni Front,” Beograd, Serbia, and Medical School University of Belgrade, Serbia
| | - Svetlana Janković-Raznatovic
- Department of Obstetrics and Gynecology, University Clinic of Gynecology and Obstetrics of “Narodni Front,” Beograd, Serbia, and Medical School University of Belgrade, Serbia
| | - Jelena Savija
- Department of Obstetrics and Gynecology, University Clinic of Gynecology and Obstetrics of “Narodni Front,” Beograd, Serbia, and Medical School University of Belgrade, Serbia
| | - Jovana Radaković
- Department of Obstetrics and Gynecology, University Clinic of Gynecology and Obstetrics of “Narodni Front,” Beograd, Serbia, and Medical School University of Belgrade, Serbia
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66
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Leone Roberti Maggiore U, Scala C, Venturini P, Remorgida V, Ferrero S. Endometriotic ovarian cysts do not negatively affect the rate of spontaneous ovulation. Hum Reprod 2014; 30:299-307. [DOI: 10.1093/humrep/deu308] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Maul LV, Morrision JE, Schollmeyer T, Alkatout I, Mettler L. Surgical therapy of ovarian endometrioma: recurrence and pregnancy rates. JSLS 2014; 18:JSLS-D-13-00223. [PMID: 25392619 PMCID: PMC4154409 DOI: 10.4293/jsls.2014.00223] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives: The study was designed to analyze preoperative clinical and surgical findings at enucleation of ovarian endometrioma with their impact on recurrence and pregnancy rates. Methods: This is a retrospective study of 550 histologically verified ovarian endometriomas operated on at the Department of Obstetrics and Gynecology, University Hospital Kiel, Germany, between 1995 and 2004. Preoperative data, surgical findings, and postoperative outcomes of 289 cases were analyzed. The average follow-up period was 12.9 years. Results: Ovarian endometriomas recurred in 23.9% of patients. Risk factors identified for recurrence of endometriomas were preoperative pain (P = .013), dysmenorrhea (P = .013), larger cyst size (>8 cm), younger age (<25 years), and preoperative cyst rupture. Factors associated with postoperative dysmenorrhea were younger age <25 years (P < .001), nulliparity (P = .020), and lager cyst size >8 cm (P = .048). Recurrence of pain was influenced by previous surgery of endometrioma (P < .05). Laparoscopy had a higher percentage of symptom-free patients than laparotomy did (49.0% vs 33.3%). Additional postoperative hormonal treatment resulted in a higher spontaneous pregnancy rate (41.4% vs 12.6%; P < .001) but a lower recurrence-free interval rate (70.5% vs 82.6%; P = .050) when compared with surgery only. Conclusions: We identified preoperative and intraoperative findings associated with higher risk of recurrence of endometrioma, pain, and dysmenorrhea. Patients desiring pregnancy benefited from postoperative hormone treatment, but no favorable results from combined therapy were observed with regard to recurrence rate.
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Affiliation(s)
- Lara V Maul
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Germany
| | - John E Morrision
- Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Thoralf Schollmeyer
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Germany
| | - Ibrahim Alkatout
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Germany
| | - Liselotte Mettler
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Germany
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A randomized study comparing the side effects and hormonal status of triptorelin and leuprorelin following conservative laparoscopic surgery for ovarian endometriosis in Chinese women. Eur J Obstet Gynecol Reprod Biol 2014; 183:164-8. [PMID: 25461372 DOI: 10.1016/j.ejogrb.2014.10.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 10/01/2014] [Accepted: 10/22/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Different gonadotropin-releasing-hormone agonist (GnRH-a) formulations with different potency and associated side effects, therefore, different compliance and persistence of therapy. This study was to evaluate the difference of hormonal profile and side effects due to hypoestrogenic status after treatment of leuprorelin and triptorelin in Chinese women with ovarian endometrioma after conservative surgical treatment. STUDY DESIGN A total of 302 women underwent laparoscopic excision of ovarian endometriomas with rASRM III and IV were enrolled in the study.Subjects were randomized into two groups with use of a random table. Twenty two patients dropped out during the study. Thus 142 patients had three doses of i.m. leuprorelin (group A) and 138 patients had three doses of i.m. triptorelin(group B) at 4 weeks intervals after surgical treatment. Menopausal symptoms were evalutaed using a questionnaire and serum sex hormonal levels were also measured during the follow-up. RESULTS At week 4 after the treatment, most of the patients in leuprorelin group have no obvious side effects. After 9 weeks, bone pain, hot flashes and sweating, and irregular bleeding were the main side effects and showed no difference between the groups. Anxiety, depression, vaginal dryness, headache, and acne rates were all significantly higher in triptorelin group than in leuprorelin group. A significant difference in FSH (p=0.003), LH (p=0.026) and E2 (p=0.002) levels between the groups were observed after 21 days of the GnRHa treatment. The FSH (p=0.021) and E2 (p=0.033) levels remained higher in the leuprorelin group than the triptorelin group after six weeks of treatment, but the difference of LH(p=0.917) level was no longer discernible. CONCLUSION Leuprorelin in down-regulating the pituitary-ovarian function was more moderate, and the hormonal levels decrease progressively and gradually, therefore, with lower rate of menopausal symptoms. Leuprorelin acetate maybe better tolerated than triptorelin.
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Coccia ME, Rizzello F, Barone S, Pinelli S, Rapalini E, Parri C, Caracciolo D, Papageorgiou S, Cima G, Gandini L. Is there a critical endometrioma size associated with reduced ovarian responsiveness in assisted reproduction techniques? Reprod Biomed Online 2014; 29:259-66. [DOI: 10.1016/j.rbmo.2014.04.019] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 03/31/2014] [Accepted: 04/01/2014] [Indexed: 11/26/2022]
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Coccia ME, Rizzello F, Romanelli C, Capezzuoli T. Adnexal masses: what is the role of ultrasonographic imaging? Arch Gynecol Obstet 2014; 290:843-54. [DOI: 10.1007/s00404-014-3327-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 06/17/2014] [Indexed: 11/24/2022]
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Ovarian Endometrioma: What the Patient Needs. J Minim Invasive Gynecol 2014; 21:505-16. [DOI: 10.1016/j.jmig.2014.01.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 01/12/2014] [Indexed: 12/16/2022]
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Yuan M, Wang WW, Li Y, Gao L, Wang T, Wang SX. Risk factors for recurrence of ovarian endometriomas after surgical excision. ACTA ACUST UNITED AC 2014; 34:213-219. [PMID: 24710935 DOI: 10.1007/s11596-014-1261-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Revised: 03/10/2014] [Indexed: 01/11/2023]
Abstract
Ovarian endometrioma is a common form of endometriosis, which may cause infertility, dysmenorrhea and pelvic pain in women of reproductive age. Although surgery is the treatment of choice for endometriomas, recurrence poses a formidable frustration. This study investigated potential risk factors of endometriomas recurrence, aiming to better understand its pathogenesis. A total of 307 patients with endometriomas were followed up for an average of 28.6 months and the 1-, 2- and 3-year cumulative recurrence rate was 9.5%, 21.9%, and 29.2%, respectively. Twenty-one potential risk factors for endometriomas recurrence were evaluated using Cox's proportional hazards models. Total revised American Fertility Society (rAFS) score was significantly associated with higher recurrence (OR=1.858, 95% CI=1.122-3.075, P=0.016), as well as younger age at surgery (OR=0.953, 95% CI=0.915-0.992, P=0.020). Semiradical surgical treatment was defined as surgical removal of cyst plus hysterectomy with preservation of bilateral or unilateral ovary, and was a significant factor that was associated with lower recurrence than the conservative surgery (OR=0.318, 95% CI=0.107-0.951, P=0.040). Postoperative pregnancy was favorable factors for disease recurrence (OR=0.217, 95% CI=0.102-0.460, P=0.000). The results suggest that endometrioma recurrence is inversely associated with age at surgery and postoperative pregnancy, and may correlate with total rAFS score and conservative surgery method.
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Affiliation(s)
- Ming Yuan
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Wen-Wen Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yan Li
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Ling Gao
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Tian Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Shi-Xuan Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Recurrence of ovarian endometrioma after second-line, conservative, laparoscopic cyst enucleation. Am J Obstet Gynecol 2014; 210:216.e1-6. [PMID: 24215855 DOI: 10.1016/j.ajog.2013.11.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 10/06/2013] [Accepted: 11/05/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVE We sought to evaluate the cumulative recurrence rate of endometrioma after a second-line, conservative, laparoscopic endometriotic cyst enucleation and to analyze the factors that influence the recurrence of endometrioma. STUDY DESIGN A multicenter retrospective cohort study was performed at 3 gynecologic surgery centers from January 2000 through December 2010. Patients surgically treated by laparoscopic enucleation of endometriotic cysts on 2 previous occasions were selected. All patients were aged <40 years at the time of the primary surgery and were followed up for at least 6 months. Endometrioma recurrence was considered when transvaginal sonography indicated a cystic mass with a diameter of ≥20 mm. RESULTS In total, 183 patients were followed up for 33.2 ± 27.7 months (range, 6-121 months). Thirty-eight (20.8%) patients experienced recurrence after the second-line surgery and 24 (13.1%) patients underwent a third surgery. The median time to recurrence was 24 ± 3.36 months (SEM) (range, 3-72 months). The cumulative recurrence rates per patient at 12, 24, 36, and 60 months after the second-line surgery were 7.7%, 13.7%, 21.3%, and 37.5%, respectively. After multivariate analysis and analysis of covariance, the revised American Fertility Society score and stage were significantly higher in patients who experience a third recurrence of endometrioma. CONCLUSION The cumulative recurrence rate of ovarian endometrioma after a second-line surgery appears to be correlated to the duration of follow-up. Severe endometriosis at the second-line surgery seems to be a factor associated with a high recurrence risk. Physicians should be cautious with regard to the postoperative management of these patients.
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Ferrero S, Remorgida V, Venturini PL, Leone Roberti Maggiore U. Norethisterone acetate versus norethisterone acetate combined with letrozole for the treatment of ovarian endometriotic cysts: a patient preference study. Eur J Obstet Gynecol Reprod Biol 2014; 174:117-22. [DOI: 10.1016/j.ejogrb.2013.11.030] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 11/12/2013] [Accepted: 11/30/2013] [Indexed: 11/28/2022]
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Moscarini M, Milazzo GN, Assorgi C, Pacchiarotti A, Caserta D. Ovarian stripping versus cystectomy: recurrence of endometriosis and pregnancy rate. Arch Gynecol Obstet 2014; 290:163-7. [DOI: 10.1007/s00404-014-3158-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 01/14/2014] [Indexed: 11/30/2022]
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Bourdel N, Canis M. Stratégies thérapeutiques des tumeurs ovariennes présumées bénignes. ACTA ACUST UNITED AC 2013; 42:802-15. [DOI: 10.1016/j.jgyn.2013.09.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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77
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78
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Lee DY, Kim HJ, Yoon BK, Choi D. Factors associated with the laterality of recurrent endometriomas after conservative surgery. Gynecol Endocrinol 2013; 29:978-81. [PMID: 24004294 DOI: 10.3109/09513590.2013.824959] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We evaluated the laterality of primary endometrioma and characteristics of patients according to the laterality of recurrent endometrioma in 140 women with recurrent endometrioma after conservative surgery. Histologically confirmed recurrent endometriomas were found on the left side in 49 patients (35.0%), the right in 44 (31.4%) and bilaterally in 47 (33.6%). The sites of primary endometrioma were not associated with those of recurrent endometrioma, and the recurrence rate in the treated ovary (59.8%) was similar to that of the intact ovary (69.0%) at the primary surgery. Proportions of stage IV endometriosis and posterior cul-de-sac obliteration were higher in patients with bilateral recurrence than in those with unilateral recurrence (p < 0.01 for all comparisons) and in patients with contralateral recurrence than in those with ipsilateral recurrence (p < 0.05 for all comparisons), but no differences were found in other characteristics of participants according to the laterality or pattern of recurrence. In conclusion, the lateral distribution of recurrent endometrioma was not associated with that of the primary lesion, and endometrioma did not recur more frequently in the treated ovary. An advanced stage and the presence of posterior cul-de-sac obliteration were factors associated with bilateral or contralateral recurrence of endometrioma.
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Affiliation(s)
- Dong-Yun Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Korea
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Ouchi N, Akira S, Mine K, Ichikawa M, Takeshita T. Recurrence of ovarian endometrioma after laparoscopic excision: Risk factors and prevention. J Obstet Gynaecol Res 2013; 40:230-6. [DOI: 10.1111/jog.12164] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 04/18/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Nozomi Ouchi
- Department of Obstetrics and Gynecology; Nippon Medical School; Tokyo Japan
| | - Shigeo Akira
- Department of Obstetrics and Gynecology; Nippon Medical School; Tokyo Japan
| | - Katsuya Mine
- Department of Obstetrics and Gynecology; Nippon Medical School; Tokyo Japan
| | - Masao Ichikawa
- Department of Obstetrics and Gynecology; Nippon Medical School; Tokyo Japan
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Campo S, Campo V, Gambadauro P. Is a positive family history of endometriosis a risk factor for endometrioma recurrence after laparoscopic surgery? Reprod Sci 2013; 21:526-31. [PMID: 24026309 DOI: 10.1177/1933719113503413] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A total of 148 patients were followed up for an average of 30.1 ± 17 months following to laparoscopic excision of ovarian endometriomas by a single surgical team. Bivariate and multivariate analyses were used to investigate the association between endometrioma recurrence and several factors, age, body mass index, family history, cyst diameter, number and location, adhesions or peritoneal implants, occurrence of spillage, postoperative treatment with gonadotropin-releasing hormone agonist, or pregnancies. The overall recurrence rate of the endometriomas was 18.2%. At bivariate analysis, recurrence rate was significantly higher in patients with a positive family history of endometriosis (40% vs 14.8%). Recurrence was also more frequent, albeit nonsignificantly, in patients with a history of dysmenorrhea, intraoperative spillage, and postoperative hormonal suppression. At multivariate analysis with logistic regression, a positive family history of endometriosis was the only variable independently associated with endometrioma recurrence following laparoscopic removal (odds ratio 3.245; 95% confidence interval: 1.090-9.661).
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Affiliation(s)
- Sebastiano Campo
- 1Institute of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
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81
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Selçuk I, Bozdağ G. Recurrence of endometriosis; risk factors, mechanisms and biomarkers; review of the literature. J Turk Ger Gynecol Assoc 2013; 14:98-103. [PMID: 24592083 DOI: 10.5152/jtgga.2013.52385] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 03/26/2013] [Indexed: 01/24/2023] Open
Abstract
Endometriosis has a wide clinical spectrum and induces a chronic inflammatory process. The incidence of endometriosis in women with dysmenorrhoea is up to 40-60%, whereas in women with subfertility is up to 20-30%. Recurrence of endometriosis varies greatly among different studies. The overall recurrence rates range between 6 to 67% according to the criteria that are taken into consideration. Which of the various reasons is more predictive for recurrence is still unclear and controversial. The main aim of post-operative medical treatment is suppressing ovarian activity leading to atrophy of endometriotic lesions. The success of treatment depends on the resorption of all residual visible lesions and the eradication of microscopic implants. The recurrent lesions might originate from residual lesions or from de novo cells. Determining risk factors for recurrence may allow the identification of subgroups at risk for disease control. Potential biomarkers for recurrence could also maintain targeted therapy.
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Affiliation(s)
- Ilker Selçuk
- Department of Obstetrics and Gynecology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Gürkan Bozdağ
- Department of Obstetrics and Gynecology, Reproductive Endocrinology and Infertility Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey
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82
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Oral contraceptives in the prevention of endometrioma recurrence: does the different progestins used make a difference? Arch Gynecol Obstet 2013; 288:821-7. [DOI: 10.1007/s00404-013-2841-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 04/01/2013] [Indexed: 10/27/2022]
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83
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Morelli M, Sacchinelli A, Venturella R, Mocciaro R, Zullo F. Postoperative administration of dienogest plus estradiol valerate versus levonorgestrel-releasing intrauterine device for prevention of pain relapse and disease recurrence in endometriosis patients. J Obstet Gynaecol Res 2013; 39:985-90. [DOI: 10.1111/jog.12030] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 11/08/2012] [Indexed: 10/27/2022]
Affiliation(s)
- Michele Morelli
- Department of Obstetrics and Gynecology; ‘Magna Graecia’ University; Catanzaro Italy
| | - Angela Sacchinelli
- Department of Obstetrics and Gynecology; ‘Magna Graecia’ University; Catanzaro Italy
| | - Roberta Venturella
- Department of Obstetrics and Gynecology; ‘Magna Graecia’ University; Catanzaro Italy
| | - Rita Mocciaro
- Department of Obstetrics and Gynecology; ‘Magna Graecia’ University; Catanzaro Italy
| | - Fulvio Zullo
- Department of Obstetrics and Gynecology; ‘Magna Graecia’ University; Catanzaro Italy
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84
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Sengoku K, Miyamoto T, Horikawa M, Katayama H, Nishiwaki K, Kato Y, Kawanishi Y, Saijo Y. Clinicopathologic risk factors for recurrence of ovarian endometrioma following laparoscopic cystectomy. Acta Obstet Gynecol Scand 2013. [DOI: 10.1111/aogs.12051] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Kazuo Sengoku
- Department of Obstetrics and Gynecology; Asahikawa Medical University; Asahikawa; Hokkaido; Japan
| | - Toshinobu Miyamoto
- Department of Obstetrics and Gynecology; Asahikawa Medical University; Asahikawa; Hokkaido; Japan
| | - Michiharu Horikawa
- Department of Obstetrics and Gynecology; Asahikawa Medical University; Asahikawa; Hokkaido; Japan
| | - Hideto Katayama
- Department of Obstetrics and Gynecology; Asahikawa Medical University; Asahikawa; Hokkaido; Japan
| | - Kunihiko Nishiwaki
- Department of Obstetrics and Gynecology; Asahikawa Medical University; Asahikawa; Hokkaido; Japan
| | - Yasuhito Kato
- Department of Obstetrics and Gynecology; Asahikawa Medical University; Asahikawa; Hokkaido; Japan
| | - Yasuyuki Kawanishi
- Department of Health Science; Asahikawa Medical University; Asahikawa; Hokkaido; Japan
| | - Yasuaki Saijo
- Department of Health Science; Asahikawa Medical University; Asahikawa; Hokkaido; Japan
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VERCELLINI PAOLO, DE MATTEIS SARA, SOMIGLIANA EDGARDO, BUGGIO LAURA, FRATTARUOLO MARIAPINA, FEDELE LUIGI. Long-term adjuvant therapy for the prevention of postoperative endometrioma recurrence: a systematic review and meta-analysis. Acta Obstet Gynecol Scand 2012; 92:8-16. [DOI: 10.1111/j.1600-0412.2012.01470.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Muneyyirci-Delale O, Anopa J, Charles C, Mathur D, Parris R, Cutler JB, Salame G, Abulafia O. Medical management of recurrent endometrioma with long-term norethindrone acetate. Int J Womens Health 2012; 4:149-54. [PMID: 22505834 PMCID: PMC3325007 DOI: 10.2147/ijwh.s27819] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Evaluate the efficacy of norethindrone acetate in the resolution of symptoms and regression of recurrent endometrioma. PATIENTS AND METHODS Retrospective chart review at SUNY Downstate Medical Center of patients with a history of surgical excision of endometrioma (with histological confirmation) and recurrent endometrioma (demonstrated by strict sonographic criterion of endometrioma) who were willing to undergo follow-up. Patients were prescribed norethindrone acetate to be taken daily with follow-up sonograms until cysts regressed. Statistical analysis included Student's t-test and a simple linear regression model to assess cyst regression over time during treatment. RESULTS Degree of pain was significantly lower on treatment when compared to baseline (P < 0.00001). Cyst size was significantly smaller in as little as 3 months (P < 0.0001). Average rate of regression with continuous treatment was 0.025 ± 0.015 cm/day. Total mean ± standard deviation regression time is 10.28 ± 8.25 months. CONCLUSION Norethindrone acetate was effective in eradicating symptoms and producing complete regression of recurrent endometriomas. It should be considered for patients who are likely to adhere to a prolonged treatment regimen and comply with recommendations for surveillance with serial sonograms.
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87
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Chen ML, Lee KC, Yang CT, Hung KH, Wu MH. Simultaneous laparoscopy for endometriotic women undergoing in vitro fertilization. Taiwan J Obstet Gynecol 2012; 51:66-70. [DOI: 10.1016/j.tjog.2012.01.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2011] [Indexed: 11/24/2022] Open
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88
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Feng D, Welker S, Körbel C, Rudzitis-Auth J, Menger MD, Montenarh M, Laschke MW. Protein kinase CK2 is a regulator of angiogenesis in endometriotic lesions. Angiogenesis 2012; 15:243-52. [DOI: 10.1007/s10456-012-9256-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Accepted: 02/09/2012] [Indexed: 12/23/2022]
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89
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Coccia ME, Rizzello F, Palagiano A, Scarselli G. The effect of the hormonal milieu of pregnancy on deep infiltrating endometriosis: serial ultrasound assessment of changes in size and pattern of deep endometriotic lesions. Eur J Obstet Gynecol Reprod Biol 2012; 160:35-9. [DOI: 10.1016/j.ejogrb.2011.10.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Revised: 08/28/2011] [Accepted: 10/12/2011] [Indexed: 10/15/2022]
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Combined oral contraceptive therapy in women with posterior deep infiltrating endometriosis. J Minim Invasive Gynecol 2011; 18:470-4. [PMID: 21777836 DOI: 10.1016/j.jmig.2011.04.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 04/15/2011] [Accepted: 04/22/2011] [Indexed: 11/21/2022]
Abstract
STUDY OBJECTIVE To estimate the effect of combined oral contraceptives (COCs) in women with deep infiltrating endometriosis. DESIGN Retrospective study (Canadian Task Force classification II-2). SETTING Tertiary care university hospital. PATIENTS One hundred six women with uncomplicated posterior deep infiltrating endometriosis scheduled to undergo laparoscopic surgery between November 2004 and November 2009. INTERVENTIONS During the waiting-list time, between surgical scheduling and laparoscopic intervention (preoperative period), 75 patients received cyclic COCs (users), and 31 received no hormone therapy (COC nonusers). MEASUREMENTS AND MAIN RESULTS Patients had undergone 2 clinical examinations, at surgical scheduling and immediately before surgery. Presence and intensity of dysmenorrhea, dyspareunia, chronic pelvic pain, and dyschezia were evaluated using a 10-point visual analog scale (VAS) (primary outcome). In both examinations, patients underwent transvaginal ultrasonography to evaluate localization and mean diameter of endometriotic nodules. Quality of life was evaluated using the Short Form-36 (SF-36) score. Mean (SD) nodule diameter at the beginning and end of the preoperative period in COC users was, respectively, 24.81 (15.13) mm and 26.66 (15.5) mm (p = .09), and in the nonuser group was, respectively, 23.09 (11.11) mm and 30.89 (19.1) mm (p = .007). In COC users, VAS scores for dysmenorrhea, dyspareunia, chronic pelvic pain, and dyschezia did not vary significantly during the preoperative period (p = .90, p = .55, p = .15, and p = .17, respectively). In nonusers, VAS scores for dysmenorrhea and dyspareunia were significantly higher at the second examination than at the first examination (p = .002 and p = .005, respectively), whereas scores for chronic pelvic pain and dyschezia did not vary during the preoperative period (p = .88 and p = .16, respectively). The Short Form-36 total score did not vary significantly during the preoperative period in either the COC user group (p = .82) or the nonusers group (p = .76). CONCLUSIONS Combined oral contraceptive therapy can have a role in restraining the progression of dysmenorrhea and dyspareunia and the growth of deep endometriotic nodules.
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91
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Bourdel N, Roman H, Mage G, Canis M. Chirurgie des endométriomes ovariens : de la physiopathologie à la prise en charge pratique pré-, per- et postopératoire. ACTA ACUST UNITED AC 2011; 39:709-21. [DOI: 10.1016/j.gyobfe.2011.07.051] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Accepted: 07/28/2011] [Indexed: 11/25/2022]
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92
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Mabrouk M, Montanari G, Guerrini M, Villa G, Solfrini S, Vicenzi C, Mignemi G, Zannoni L, Frasca C, Di Donato N, Facchini C, Del Forno S, Geraci E, Ferrini G, Raimondo D, Alvisi S, Seracchioli R. Does laparoscopic management of deep infiltrating endometriosis improve quality of life? A prospective study. Health Qual Life Outcomes 2011; 9:98. [PMID: 22054310 PMCID: PMC3247061 DOI: 10.1186/1477-7525-9-98] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Accepted: 11/06/2011] [Indexed: 01/30/2023] Open
Abstract
Background Deep infiltrating endometriosis (DIE) can affect importantly patients' quality of life (QOL). The aim of this study is to evaluate the impact of the laparoscopic management of DIE on QOL after six months from treatment. Methods It is a prospective cohort study. In a tertiary care university hospital, between April 2008 and December 2009, 100 patients underwent laparoscopic management of DIE and completed preoperatively and 6-months postoperatively a QOL questionnaire, the short form 36 (SF-36). Quality of life was measured through the SF-36 scores. Intra-operative details of disease site, number of lesions, type of intervention, period of hospital stay and peri-operative complications were noted. Results Six months postoperatively all the women had a significant improvement in every scale of the SF-36 (p < 0,0005). Among patients with intestinal DIE, significant differences in postoperative scores of SF-36 were not detected between patients submitted to nodule shaving and segmental resection (p > 0.05). There was no significant difference in the SF-36 scores at 6 months from surgery between patients who received postoperative medical treatment and patients who did not (p > 0.05). Conclusions Laparoscopic excision of DIE lesions significantly improves general health and psycho-emotional status at six months from surgery without differences between patients submitted to intestinal segmental resection or intestinal nodule shaving.
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Affiliation(s)
- Mohamed Mabrouk
- Minimally Invasive Gynaecological Surgery Unit, S.Orsola Hospital, University of Bologna, Italy
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93
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Mereu L, Florio P, Carri G, Pontis A, Petraglia F, Mencaglia L. Clinical outcomes associated with surgical treatment of endometrioma coupled with resection of the posterior broad ligament. Int J Gynaecol Obstet 2011; 116:57-60. [DOI: 10.1016/j.ijgo.2011.08.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Revised: 08/30/2011] [Accepted: 10/03/2011] [Indexed: 11/26/2022]
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94
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Gelbaya TA, Nardo LG. Evidence-based management of endometrioma. Reprod Biomed Online 2011; 23:15-24. [DOI: 10.1016/j.rbmo.2010.11.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Revised: 09/25/2010] [Accepted: 11/11/2010] [Indexed: 11/15/2022]
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95
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Coccia ME, Rizzello F, Palagiano A, Scarselli G. Long-term follow-up after laparoscopic treatment for endometriosis: multivariate analysis of predictive factors for recurrence of endometriotic lesions and pain. Eur J Obstet Gynecol Reprod Biol 2011; 157:78-83. [DOI: 10.1016/j.ejogrb.2011.02.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2010] [Revised: 01/03/2011] [Accepted: 02/25/2011] [Indexed: 11/26/2022]
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96
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Carmona F, Martínez-Zamora MA, Rabanal A, Martínez-Román S, Balasch J. Ovarian cystectomy versus laser vaporization in the treatment of ovarian endometriomas: a randomized clinical trial with a five-year follow-up. Fertil Steril 2011; 96:251-4. [PMID: 21575941 DOI: 10.1016/j.fertnstert.2011.04.068] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Revised: 04/02/2011] [Accepted: 04/18/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To investigate the effect of two laparoscopic techniques for treatment of ovarian endometriomas on recurrence rate. DESIGN Prospective randomized clinical trial. SETTING University teaching hospital. PATIENT(S) Ninety women with ovarian endometriomas. INTERVENTION(S) Patients were randomly selected to undergo either laparoscopic cystectomy (group 1) or laser vaporization (group 2) of ovarian endometrioma. MAIN OUTCOME MEASURE(S) Recurrence, evaluated by ultrasound scan examination, was assessed at 12 and 60 months of follow-up. RESULT(S) Endometrioma recurrence rate was higher, though not significantly different, in group 2 at 60 months of follow-up. Nevertheless, at 12 months of follow-up recurrences were statistically higher in group 2. CONCLUSION(S) The comparison between laparoscopic laser ablation and laparoscopic cystectomy for ovarian endometriomas after long-term follow-up showed earlier recurrences and a higher recurrence rate in the laser group, although at 5 years of follow-up there were no statistically significant differences.
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Affiliation(s)
- Francisco Carmona
- Institut Clínic of Gynecology, Obstetrics, and Neonatology, Faculty of Medicine, University of Barcelona, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.
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97
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Zhu W, Tan Z, Fu Z, Li X, Chen X, Zhou Y. Repeat transvaginal ultrasound-guided aspiration of ovarian endometrioma in infertile women with endometriosis. Am J Obstet Gynecol 2011; 204:61.e1-6. [PMID: 20934676 DOI: 10.1016/j.ajog.2010.08.040] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Revised: 07/06/2010] [Accepted: 08/24/2010] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We sought to investigate the effectiveness of repeated transvaginal ultrasound-guided aspiration of endometriomas in infertile women with endometriosis. STUDY DESIGN A retrospective study was performed in our department of reproductive health on 129 infertile women who underwent monthly repeated transvaginal aspiration of endometriomas. The recurrence and pregnancy were monitored during a follow-up period of 24 months. RESULTS Recurrences of cysts were found in 118 (91.5%) patients in the first postaspirate month and 86 (66.7%) in the second, 60 (46.5%) in the third, 28 (21.7%) in the fourth, 12 (9.3%) in the fifth, 7 (5.4%) in the sixth, and 36 (27.9%) in the 24th postaspiration month. Mean 3.1 ± 2.8 times of aspirations per patient were performed without any adverse effect. There was a linear regression relationship between the change of times of aspirations and the chance of recurrence of cysts. Overall pregnancy rate of 43.4% (56/129) was obtained. CONCLUSION The repetitive aspiration of endometriomas is an effective therapeutic option in patients with endometriosis.
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Affiliation(s)
- Wenjie Zhu
- Department of Reproductive Health, Shen-Zhen City Maternity and Child Healthcare Hospital, Shen-Zhen, Guang-Dong Province, Peoples Republic of China.
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98
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Hayasaka S, Ugajin T, Fujii O, Nabeshima H, Utsunomiya H, Yokomizo R, Yuki H, Terada Y, Murakami T, Yaegashi N. Risk factors for recurrence and re-recurrence of ovarian endometriomas after laparoscopic excision. J Obstet Gynaecol Res 2010; 37:581-5. [PMID: 21159045 DOI: 10.1111/j.1447-0756.2010.01409.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM Since ovarian endometrioma is frequently diagnosed in women of reproductive age, laparoscopic excision of the endometrioma is performed for most cases. However, endometriomas frequently recurs even after repeated surgical procedures. The aim of our study is to identify risk factors for recurrence and re-recurrence of endometriomas after the first and second laparoscopic excision. MATERIAL & METHODS We retrospectively evaluated 173 patients who had a minimum of one year postoperative follow-up after the laparoscopic excision of endometriomas. Ten and eight factors were evaluated to assess their effect on the risk of recurrence and re-recurrence, respectively. Factors were analyzed using univariate and the Cox regression test. RESULTS The overall rate of recurrence and re-recurrence were 45.1% and 45.5%, respectively. A high revised American Society for Reproductive Medicine score (1997) was associated with an increased risk of recurrence. Only postoperative pregnancy was associated with a decreased risk of recurrence. Short periods of normal menstruation without pregnancy or gonadotrophin-releasing hormone analogues from first surgery to recurrence were associated with higher rate of re-recurrence. CONCLUSIONS A high revised American Society for Reproductive Medicine score was a risk factor, and postoperative pregnancy was protective against recurrence. The patient with short periods of normal menstruation without pregnancy or gonadotrophin-releasing hormone analogues from first surgery to recurrence had a high risk of re-recurrence.
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Affiliation(s)
- Shinichi Hayasaka
- Department of Obstetrics and Gynecology, Tohoku University School of Medicine, Sendai, Miyagi, Japan.
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99
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Vercellini P, Crosignani P, Somigliana E, Vigano P, Frattaruolo MP, Fedele L. 'Waiting for Godot': a commonsense approach to the medical treatment of endometriosis. Hum Reprod 2010; 26:3-13. [DOI: 10.1093/humrep/deq302] [Citation(s) in RCA: 145] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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100
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Lee DY, Bae DS, Yoon BK, Choi D. Post-operative cyclic oral contraceptive use after gonadotrophin-releasing hormone agonist treatment effectively prevents endometrioma recurrence. Hum Reprod 2010; 25:3050-4. [DOI: 10.1093/humrep/deq279] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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