1
|
Razakamanantsoa L, Bodard S, Najdawi M, Dabi Y, Bendifallah S, Touboul C, Lehrer R, Agbonon R, Di Giuseppe R, Barral M, Bazot M, Brun JL, Roman H, Marcelin C, Thomassin-Naggara I, Cornelis FH. Surgical and Percutaneous Image-guided Therapies of Abdominal Wall Endometriosis: a Systematic Review of Current Evidence. J Minim Invasive Gynecol 2024:S1553-4650(24)00266-8. [PMID: 38901689 DOI: 10.1016/j.jmig.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 06/09/2024] [Accepted: 06/10/2024] [Indexed: 06/22/2024]
Abstract
OBJECTIVE Despite various surgical and non-surgical strategies for abdominal wall endometriosis, the lack of definitive guidance on optimal treatment choice leads to clinical uncertainty. This review scrutinizes the safety and efficacy of abdominal wall endometriosis treatments to aid in decision-making. DATA SOURCES We performed a systematic literature review of PubMed, Embase and Cochrane Library databases from 1947 until December 2023. METHODS OF STUDY SELECTION A comprehensive literature search identified studies that assessed both surgical and nonsurgical interventions, including high-intensity focused ultrasound (HIFU), cryoablation, radiofrequency ablation (RFA), and microwave ablation (MWA). This review is registered in NIHR-PROSPERO (CRD 42023494969). Local tumor control (LTC), local pain relief (LPR) and adverse events (AE) were recorded. TABULATION, INTEGRATION, AND RESULTS This review included 51 articles among 831 identified. All study designs were considered eligible for inclusion. A total of 2,674 patients are included: 2,219 patients (83%) undergoing surgery, and 455 (17%) undergoing percutaneous interventions (342 HIFU, 103 cryoablation, 1 RFA, 9 MWA). Follow-up length was 18 months in median, ranging from 1 to 235 months. Overall LTC rates ranged from 86% to 100%. Surgical interventions consistently demonstrated the highest rate of LTC with a median rate of 100%, and LPR with a median rate of 98.2% (95% confidence interval [CI]: 93.9-97.7). HIFU showed median LTC and LPR rates, respectively of 95.65% (95% CI, 87.7-99.9) and 76.1% (95% CI, 61.8-90.4); and cryoablation of 85.7% (95% CI, 66.0-99.9) and 79.2% (95% CI, 67.4-91.03). Minor AE were reported after surgery in 17.5% of patients (225/1284) including 15.9% (199/1284) of mesh implantation; 76.4% (239/313) after HIFU; and 8.7 % (9/103) after cryoablation. Severe AE were reported in 25 patients in the surgery group and 1 in the percutaneous group. CONCLUSION The safety profile and efficacy of nonsurgical interventions support their clinical utility for management of abdominal wall endometriosis.
Collapse
Affiliation(s)
- Leo Razakamanantsoa
- Sorbonne University, Department of Specialized Radiology and Interventional Imaging, Tenon Hospital, 4 rue de la Chine, 75020 Paris, France; Saint-Antoine Research Center (CRSA), INSERM, CNRS, Sorbonne University, F-75012, Paris, France.
| | - Sylvain Bodard
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Milan Najdawi
- Sorbonne University, Department of Specialized Radiology and Interventional Imaging, Tenon Hospital, 4 rue de la Chine, 75020 Paris, France
| | - Yohann Dabi
- Saint-Antoine Research Center (CRSA), INSERM, CNRS, Sorbonne University, F-75012, Paris, France; Sorbonne University, Department of Obstetrics and Gynecology, Tenon Hospital, 4 rue de la Chine, 75020 Paris, France
| | - Sofiane Bendifallah
- American Hospital of Paris, Department of Gynecology, 40 rue Chauveau, 92200, Neuilly-sur-Seine, France
| | - Cyril Touboul
- Sorbonne University, Department of Obstetrics and Gynecology, Tenon Hospital, 4 rue de la Chine, 75020 Paris, France
| | - Raphael Lehrer
- Sorbonne University, Department of Specialized Radiology and Interventional Imaging, Tenon Hospital, 4 rue de la Chine, 75020 Paris, France
| | - Remi Agbonon
- Sorbonne University, Department of Specialized Radiology and Interventional Imaging, Tenon Hospital, 4 rue de la Chine, 75020 Paris, France
| | - Raphael Di Giuseppe
- Sorbonne University, Department of Specialized Radiology and Interventional Imaging, Tenon Hospital, 4 rue de la Chine, 75020 Paris, France
| | - Matthias Barral
- Sorbonne University, Department of Specialized Radiology and Interventional Imaging, Tenon Hospital, 4 rue de la Chine, 75020 Paris, France
| | - Marc Bazot
- Sorbonne University, Department of Specialized Radiology and Interventional Imaging, Tenon Hospital, 4 rue de la Chine, 75020 Paris, France
| | - Jean-Luc Brun
- Department of Gynecology, CHU Bordeaux, place Amélie Raba Léon, 33076 Bordeaux, France
| | - Horace Roman
- Franco-European Multidisciplinary Endometriosis Institute, Clinique Tivoli-Ducos (Drs. Boulus, Merlot, Chanavaz-Lacheray, Dennis, and Roman), Bordeaux, France; Franco-European Multidisciplinary Endometriosis Institute Middle East Clinic (Drs. Merlot, Kade, and Roman), Burjeel Medical City, Abu Dhabi, United Arab Emirates; Department of Gynecology and Obstetrics (Dr. Roman), Aarhus University Hospital, Denmark.
| | - Clement Marcelin
- Department of Radiology, CHU Bordeaux, place Amélie Raba Léon, 33076 Bordeaux, France
| | - Isabelle Thomassin-Naggara
- Sorbonne University, Department of Specialized Radiology and Interventional Imaging, Tenon Hospital, 4 rue de la Chine, 75020 Paris, France; Saint-Antoine Research Center (CRSA), INSERM, CNRS, Sorbonne University, F-75012, Paris, France
| | - Francois H Cornelis
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Department of Radiology, Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA
| |
Collapse
|
2
|
Knorren ER, de Ridder LA, Nijholt IM, Dijkstra JR, Braat MNGJA, Huirne JAF, Boomsma MF, Schutte JM. Effectiveness and complication rates of high intensity focused ultrasound treatment for abdominal wall endometriosis: A systematic review. Eur J Obstet Gynecol Reprod Biol 2024; 297:15-23. [PMID: 38555851 DOI: 10.1016/j.ejogrb.2024.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/18/2024] [Accepted: 03/22/2024] [Indexed: 04/02/2024]
Abstract
In this review, a systematic literature search on the effectiveness and complication rates of ultrasound-guided and magnetic resonance-guided high-intensity focused ultrasound (USg-/MRgHIFU) for abdominal wall endometriosis (AWE) was conducted in six databases in May/June 2023. Original articles of (non)randomized trials, cohort studies, case-control studies and case series published in peer-reviewed journals were included. Of the included studies the level of evidence (LoE) and methodological quality using the ROBINS-I and IHE-QAT was assessed. Primary outcomes were non-perfused volume ratio (NPV%), lesion size, pain scores, side effects and complication rates according to Society of Interventional Radiology (SIR) guidelines. Secondary outcomes were recurrence and re-intervention rates. Seven cohort studies (one of good methodological quality) (LoE 3) on USgHIFU were included (n = 212, AWE lesions = 240-245). Six months after USgHIFU treatment, pain scores were reduced with 3.3-5.2 points (baseline: 5.1-6.8, n = 135). Self-limiting side effects were pain (85.7 % (114/133)) and swelling (34.6 % (46/133)) in the treatment area. Complications occurred in 17.7 % (32/181), all of which were minor. Recurrence occurred in 12.8 % (11/86). Three of these seven cohort studies compared USgHIFU (n = 61) with surgical excision (n = 74). Pooled results showed no significant differences in pain scores, complications (resp. 26.3 % (10/38) vs. 32.6 % (15/46) (p = 0.53)) and recurrences (resp. 4.9 % (3/61) vs. 5.4 % (4/74) (p = 0.90)). This systematic review suggests that HIFU is an effective and safe treatment option for AWE. USgHIFU treatment led to reduced pain scores and lesion size, was free of major complications and had a pooled recurrence rate of 12.8 %. Compared to surgical excision pooled results showed no significant differences in pain scores, complications and recurrences after USgHIFU. However, many of the included studies had limitations in their methodological quality and therefore the results should be interpreted with caution. Well-structured high-quality randomized controlled trials comparing HIFU to standard care should be conducted to provide more conclusive evidence.
Collapse
Affiliation(s)
- Elisabeth R Knorren
- Department of Obstetrics and Gynecology, Isala Hospital, Dokter van Deenweg 2, 8025AB Zwolle, The Netherlands; Department of Radiology, Isala Hospital, Dokter van Deenweg 2, 8025AB Zwolle, The Netherlands.
| | - Larissa A de Ridder
- Department of Obstetrics and Gynecology, Isala Hospital, Dokter van Deenweg 2, 8025AB Zwolle, The Netherlands
| | - Ingrid M Nijholt
- Department of Radiology, Isala Hospital, Dokter van Deenweg 2, 8025AB Zwolle, The Netherlands
| | - Jeroen R Dijkstra
- Department of Obstetrics and Gynecology, Isala Hospital, Dokter van Deenweg 2, 8025AB Zwolle, The Netherlands
| | - Manon N G J A Braat
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584XC Utrecht, The Netherlands
| | - Judith A F Huirne
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centre, location VUmc, Amsterdam Research Institute, Reproduction and Development, De Boelelaan 1117, 1081HV Amsterdam, The Netherlands
| | - Martijn F Boomsma
- Department of Radiology, Isala Hospital, Dokter van Deenweg 2, 8025AB Zwolle, The Netherlands; Imaging & Oncology Division, Image Sciences Institute, University Medical Center Utrecht, Heidelberglaan 100, 3584XC Utrecht, The Netherlands
| | - Joke M Schutte
- Department of Obstetrics and Gynecology, Isala Hospital, Dokter van Deenweg 2, 8025AB Zwolle, The Netherlands
| |
Collapse
|
3
|
Triantafyllidou O, Mili N, Kalampokas T, Vlahos N, Kalampokas E. Surgical management of abdominal wall sheath and rectus abdominis muscle endometriosis: a case report and literature review. Front Surg 2024; 10:1335931. [PMID: 38274352 PMCID: PMC10808685 DOI: 10.3389/fsurg.2023.1335931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 12/28/2023] [Indexed: 01/27/2024] Open
Abstract
Introduction Endometriosis, defined as the presence of endometrial glands and stroma outside the uterine cavity, mainly affects the pelvic viscera and peritoneum. Endometriosis can also occur at sites of surgical incisions on the abdominal wall, mainly in women with a history of cesarean section (CS). The incidence of abdominal wall endometriosis after CS reaches 1%. Clinical suspicion, along with imaging, plays a crucial role in diagnosis. The preferred treatment involves extensive surgical excision with clear margins, ensuring a definitive diagnosis through histopathology examination. Case presentation This case report is of a 44-year-old woman with a history of two CS procedures who developed pain and pigmentation at the incisional site one year after the last CS. Thirteen years after the surgical excision of an abdominal wall endometriosis (AWE) mass, followed by hormone therapy, she presented in our hospital with worsening pain for further management. Pelvic MRI findings were consistent with AWE. During surgery, the abdominal wall endometriosis foci were removed, and the defect in the aponeurosis was repaired using a dual-sided mesh in a tension-free procedure. Conclusion Although AWE is a rare condition, we foresee an increase in cases because of the ever-increasing CS rates and the important association between AWE and CS. Healthcare practitioners should remain vigilant for this condition in women of reproductive age who exhibit cyclic pain, a palpable mass in the abdomen, and a background of previous uterine surgeries.
Collapse
Affiliation(s)
| | | | | | | | - Emmanouil Kalampokas
- Second Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| |
Collapse
|
4
|
Jouffrieau C, Cazzato RL, Gabriele V, Faller E, Weiss J, Host A, Garnon J, Garbin O, Gangi A. Percutaneous Imaging-guided Cryoablation of Endometriosis Scars of the Anterior Abdominal Wall. J Minim Invasive Gynecol 2023; 30:890-896. [PMID: 37422051 DOI: 10.1016/j.jmig.2023.06.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/27/2023] [Accepted: 06/27/2023] [Indexed: 07/10/2023]
Abstract
STUDY OBJECTIVE To evaluate the safety and clinical efficacy of percutaneous imaging-guided cryoablation for the management of anterior abdominal wall endometriosis. DESIGN Patients with abdominal wall endometriosis underwent percutaneous imaging-guided cryoablation and had a 6-month follow-up. SETTING Data dealing with patients' and anterior abdominal wall endometriosis (AAWE) characteristics, cryoablation, and clinical and radiologic outcomes were retrospectively collected and analyzed. PATIENTS Twenty-nine consecutive patients underwent cryoablation from June 2020 to September 2022. INTERVENTIONS Interventions were performed under US/computed tomography (CT) guidance or magnetic resonance imaging (MRI) guidance. Cryoprobes were directly inserted into the AAWE, and cryoablation was performed with a single 5 to 10 minute freezing cycle, which was stopped when the iceball expanded 3 to 5 mm beyond AAWE borders as assessed on intra-procedural cross-sectional imaging. MEASUREMENTS AND MAIN RESULTS Fifteen patients (15/29; 51.7%) had prior endometriosis, 28 (28/29; 95.5%) had previous cesarian section, and 22 (22/29; 75.9%) referred association between symptoms and menses. Cryoablation was performed under local (16/29; 55.2%) or general anesthesia (13/29; 44.8%) and mainly in an out-patient basis (18/20; 62%). There was only one (1/29; 3.5%) minor procedure-related complication. Complete symptom relief was recorded in 62.1% (18/29) and 72.4% (21/29) patients at 1 and 6 months, respectively. In the whole population, pain significantly dropped at 6 months compared to the baseline (1.1 ± 2.3; range 0-8 vs 7.1 ± 1.9; range 3-10; p <.05). Eight (8/29; 27.6%) patients presented residual symptoms at 6 months, and 4 (4/29; 13.8%) had an MRI-confirmed residual/recurring disease. Contrast-enhanced MRI obtained for the first 14 (14/29; 48.3%) patients of the series, all without signs of residual/recurring disease, demonstrated a significantly smaller ablation area compared to the baseline volume of the AAWE (1.0 cm3 ± 1.4; range 0-4.7; vs 11.1 ± 9.9 cm3; range 0.6-36.4; p <.05). CONCLUSION Percutaneous imaging-guided cryoablation of AAWE is safe and clinically effective in achieving pain relief.
Collapse
Affiliation(s)
| | - Roberto Luigi Cazzato
- Department of Interventional Radiology (Drs. Cazzato, Weiss, Garnon, and Gangi), University Hospital of Strasbourg, Strasbourg, France
| | - Victor Gabriele
- Gynecology Unit, CMCO (Drs. Jouffrieau, Gabriele, Faller, Host, and Garbin)
| | - Emilie Faller
- Gynecology Unit, CMCO (Drs. Jouffrieau, Gabriele, Faller, Host, and Garbin)
| | - Julia Weiss
- Department of Interventional Radiology (Drs. Cazzato, Weiss, Garnon, and Gangi), University Hospital of Strasbourg, Strasbourg, France
| | - Aline Host
- Gynecology Unit, CMCO (Drs. Jouffrieau, Gabriele, Faller, Host, and Garbin)
| | - Julien Garnon
- Department of Interventional Radiology (Drs. Cazzato, Weiss, Garnon, and Gangi), University Hospital of Strasbourg, Strasbourg, France
| | - Olivier Garbin
- Gynecology Unit, CMCO (Drs. Jouffrieau, Gabriele, Faller, Host, and Garbin)
| | - Afshin Gangi
- Department of Interventional Radiology (Drs. Cazzato, Weiss, Garnon, and Gangi), University Hospital of Strasbourg, Strasbourg, France
| |
Collapse
|