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Comptour A, Figuier C, Pereira B, Chauvet P, Bourdel N, Canis M. Endometriosis: Age at diagnosis and the severity of the disease. J Gynecol Obstet Hum Reprod 2024; 53:102759. [PMID: 38467186 DOI: 10.1016/j.jogoh.2024.102759] [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: 11/30/2023] [Revised: 02/27/2024] [Accepted: 02/27/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Endometriosis is often described as a progressive disease beginning with menarche and menstrual bleeding. However, this is controversial, as the origin of the disease remains unknown. The objective of this study was to investigate the association between the severity of endometriosis and age at initial diagnosis. MATERIAL AND METHODS This prospective multicenter cohort study included 964 patients, newly and histologically diagnosed with endometriosis during laparoscopic treatment. The main outcome measures were diagnostic lesions with staging according to rAFS (revised American Fertility Society) scores, intensity of pain based on VAS (Visual Analog Scale) scores and quality of life from SF-36 questionnaire results. Age was treated as a categorical variable. Univariate and multivariable analyses (linear and multinomial ordinal) were conducted taking into account two by two multiple comparisons. The results were expressed with effect sizes and 95 % confidence intervals. MAIN FINDINGS No significant association between age and rAFS stage was found (p = 0.053). The percentage of patients with a deep nodule ≥ 2 cm was respectively 20 %, 25 %, 21 %, 18 % and 9 % for patients aged ≤ 25, 26-30, 31-35, 36-40 and >40 years respectively (p = 0.005). For dysmenorrhea, 64 %, 61 %, 54 %, 51 % and 32 % of patients aged ≤25, 26-30, 31-35, 36-40 and >40 years respectively reported a VAS score of ≥7 (p ≤ 0.001). CONCLUSION Prospective data obtained in patients newly diagnosed with endometriosis, revealed that the rAFS score is not related to patient age, and that the percentage of patients with a nodule ≥ 2 cm and severe dysmenorrhea did not increase with age. These percentages were significantly lower in patients aged > 40.
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Affiliation(s)
- Aurélie Comptour
- INSERM, CIC 1405 CRECHE Unit, CHU Clermont-Ferrand, Department of Gynecological Surgery, Clermont-Ferrand, France
| | - Claire Figuier
- CHU Clermont-Ferrand, Department of Gynecologic Surgery. CHU Estaing. 1 Place Lucie et Raymond Aubrac 63000 Clermont Ferrand France; Université Clermont Auvergne, EnCoV, Institut Pascal, UMR 6602 CNRS, SIGMA Clermont, F-63000 Clermont-Ferrand, France
| | - Bruno Pereira
- CHU Clermont-Ferrand, Biostatistics, Clermont-Ferrand, France
| | - Pauline Chauvet
- CHU Clermont-Ferrand, Department of Gynecologic Surgery. CHU Estaing. 1 Place Lucie et Raymond Aubrac 63000 Clermont Ferrand France; Université Clermont Auvergne, EnCoV, Institut Pascal, UMR 6602 CNRS, SIGMA Clermont, F-63000 Clermont-Ferrand, France
| | - Nicolas Bourdel
- CHU Clermont-Ferrand, Department of Gynecologic Surgery. CHU Estaing. 1 Place Lucie et Raymond Aubrac 63000 Clermont Ferrand France; Université Clermont Auvergne, EnCoV, Institut Pascal, UMR 6602 CNRS, SIGMA Clermont, F-63000 Clermont-Ferrand, France
| | - Michel Canis
- CHU Clermont-Ferrand, Department of Gynecologic Surgery. CHU Estaing. 1 Place Lucie et Raymond Aubrac 63000 Clermont Ferrand France; Université Clermont Auvergne, EnCoV, Institut Pascal, UMR 6602 CNRS, SIGMA Clermont, F-63000 Clermont-Ferrand, France.
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Long-Term Evolution of Quality of Life and Symptoms Following Surgical Treatment for Endometriosis: Different Trajectories for Which Patients? J Clin Med 2020; 9:jcm9082461. [PMID: 32752110 PMCID: PMC7463511 DOI: 10.3390/jcm9082461] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/24/2020] [Accepted: 07/30/2020] [Indexed: 02/07/2023] Open
Abstract
Many studies have shown a global efficacy of laparoscopic surgery for patients with endometriosis in reducing painful symptoms and improving quality of life (QoL) in the short and long-term. The aim of this study was to analyze the different trajectories of long-term evolution in QoL and symptoms following surgical treatment for endometriosis, and to identify corresponding patient profiles. This prospective and multicenter cohort study concerned 962 patients who underwent laparoscopic treatment for endometriosis. QoL was evaluated using the Short Form (SF)-36 questionnaire and intensity of pain was reported using a visual analog scale prior to surgery and at 6, 12, 18, 24 and 36 months after surgery. Distinctive trajectories of pain and QoL evolution were identified using group-based trajectory modeling, an approach which gathers individuals into meaningful subgroups with statistically similar trajectories. Pelvic symptom trajectories (models of the evolution of dysmenorrhea, dyspareunia and chronic pelvic pain intensity over years) correspond to (1) patients with no pain or pain no longer after surgery, (2) patients with the biggest improvement in pain and (3) patients with continued severe pain after surgery. Our study reveals clear trajectories for the progression of symptoms and QoL after surgery that correspond to clusters of patients. This information may serve to complete information obtained from epidemiological methods currently used in selecting patients eligible for surgery.
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Pécout M, Jean Dit Gautier E, Doucède G, Collinet P, Rubod C. Pelvic endometriosis: Refer to the surgeon at the right moment: Pelvic endometriosis: When refer to the surgeon? J Gynecol Obstet Hum Reprod 2020; 49:101701. [PMID: 32028037 DOI: 10.1016/j.jogoh.2020.101701] [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: 07/26/2019] [Revised: 01/16/2020] [Accepted: 01/24/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND As endometriosis is not a single condition but different morphological types, it is easy to conceive that its management allow for a diversity of approaches. The objective of this literature review is about a simplified pathway through care for patients with endometriosis, and to target the right time for surgical treatment. METHODS Through a literature and references review, the different surgical care arrangements according to attainment, to symptoms and to the patients demands and expectations are reviewed. RESULTS An existing literature and recommendations synthesis has been done, and it was found that an optimum medical or surgical care rely on a multidisciplinary approach. Asymptomatic patients should not have surgery, and the medical treatment precede surgical treatment in numerous indications. In case of a surgical need, the right moment is determined by the recommendations, as noted in this article. Different aspects are necessary, the symptomatology, the intend to be pregnant and the recurrence of lesions in particular, but also the use of medically assisted reproduction or not. CONCLUSION In order to optimize the surgical treatment of patients with endometriosis, it is advisable to not refer these patients to the surgeon not too soon and not too late, furthermore if he's an expert. In all cases the treatment is multidisciplinary, and the most difficult cases are referred to multidisciplinary consultative reunion. The surgical treatment relies on "centre of expertise's" existence for some specific forms of deep endometriosis. The surgical treatment is a question of both pathology and timing. BRIEF SUMMARY In order to optimize the surgical treatment of endometriosis, it is advisable to refer patients to the surgeon at the right moment.
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Affiliation(s)
- Marie Pécout
- Gynaecology Surgery Department, CHU Lille, F-59000, Lille, France.
| | - Estelle Jean Dit Gautier
- Gynaecology Surgery Department, CHU Lille, F-59000, Lille, France; Lille University, Faculty of Medicine, F-59000, Lille, France.
| | - Guillaume Doucède
- Gynaecology Surgery Department, CHU Lille, F-59000, Lille, France; Lille University, Faculty of Medicine, F-59000, Lille, France.
| | - Pierre Collinet
- Gynaecology Surgery Department, CHU Lille, F-59000, Lille, France; Lille University, Faculty of Medicine, F-59000, Lille, France.
| | - Chrystèle Rubod
- Gynaecology Surgery Department, CHU Lille, F-59000, Lille, France; Lille University, Faculty of Medicine, F-59000, Lille, France.
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Bourdel N, Paracchini S, Chauvet P, Fava V, Gałczyński K, Canis M. Surgical Technique for Endometrioma in 10 Steps. J Minim Invasive Gynecol 2019; 27:260-261. [PMID: 31376583 DOI: 10.1016/j.jmig.2019.07.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 07/14/2019] [Accepted: 07/25/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Laparoscopic cystectomy for endometrioma has the advantages of a minimally invasive approach. The standardization and description of the technique are the main objectives of this video. We described the surgery in 10 steps, which could help to make this procedure easier and safer. DESIGN Step-by-step video demonstration of the technique. SETTING A French university tertiary care hospital. INTERVENTION Two standardized laparoscopic cystectomy were recorded to realize the video. The local institutional review board ruled that approval was not required because the video describes a technique and does not report a clinical case. This video presents a systematic approach to cystectomy for endometrioma clearly divided into 10 steps: (1) preoperative evaluation [1]; (2) diagnosis and exploration [2]; (3) adhesiolysis, mobilization of the ovary; (4) cyst rupture, exposition of the entry site; (5) identification of the cleavage plan; (6) endometrioma easy dissection; (7) endometrioma difficult dissection; (8) hemostasis, reconstruction of the ovary [3]; (9) exploration of the ovarian fossa; and (10) washing, extraction of the cyst [3,4]. CONCLUSION Standardization of laparoscopic cystectomy for endometrioma could make this procedure easier and safer to perform. The 10 steps presented help to perform each part of the surgery in a logical sequence, making the procedure easier to realize. Moreover, the standardization of the surgical techniques may reduce the learning curve.
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Affiliation(s)
- Nicolas Bourdel
- Department of Gynaecological Surgery (Drs. Bourdel, Paracchini, Chauvet, Fava, and Canis), CHU Estaing, Clermont-Ferrand, France; Endoscopy and Computer Vision, IP, UMR 6602 Centre National de la Recherche Scientifique (Drs. Bourdel, Chauvet, and Canis), Université Clermont Auvergne, Clermont-Ferrand, France.
| | - Sara Paracchini
- Department of Gynaecological Surgery (Drs. Bourdel, Paracchini, Chauvet, Fava, and Canis), CHU Estaing, Clermont-Ferrand, France; Department of Surgical Sciences (Dr. Paracchini), AOU Città della Scienza e della Salute di Torino, Torino, Italy
| | - Pauline Chauvet
- Department of Gynaecological Surgery (Drs. Bourdel, Paracchini, Chauvet, Fava, and Canis), CHU Estaing, Clermont-Ferrand, France; Endoscopy and Computer Vision, IP, UMR 6602 Centre National de la Recherche Scientifique (Drs. Bourdel, Chauvet, and Canis), Université Clermont Auvergne, Clermont-Ferrand, France
| | - Valentina Fava
- Department of Gynaecological Surgery (Drs. Bourdel, Paracchini, Chauvet, Fava, and Canis), CHU Estaing, Clermont-Ferrand, France; Department of General Surgery and Medical Surgical Specialities (Dr. Fava), University of Catania, Catania, Italy
| | - Krzysztof Gałczyński
- Faculty of Natural Sciences (Dr. Gałczyński), Siedlce University of Natural Sciences and Humanities, Siedlce, Poland; Second Department of Gynaecological Oncology (Dr. Gałczyński), St. John's of Dukia Cancer Centre of Lublin, Lublin, Poland
| | - Michel Canis
- Department of Gynaecological Surgery (Drs. Bourdel, Paracchini, Chauvet, Fava, and Canis), CHU Estaing, Clermont-Ferrand, France; Endoscopy and Computer Vision, IP, UMR 6602 Centre National de la Recherche Scientifique (Drs. Bourdel, Chauvet, and Canis), Université Clermont Auvergne, Clermont-Ferrand, France
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Identification of Predictive Factors in Endometriosis for Improvement in Patient Quality of Life. J Minim Invasive Gynecol 2019; 27:712-720. [PMID: 31146030 DOI: 10.1016/j.jmig.2019.05.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 05/15/2019] [Accepted: 05/18/2019] [Indexed: 12/20/2022]
Abstract
STUDY OBJECTIVE To investigate predictive factors for change in quality of life (QOL) between pre- and postoperative periods in patients with endometriosis. DESIGN A prospective and multicenter cohort study. SETTING Five districts including a tertiary referral center and private and general public hospitals. PATIENTS Nine hundred eighty-one patients aged 15 to 50 years underwent laparoscopic treatment (preferred approach) for endometriosis between January 2004 and December 2012. INTERVENTIONS Laparoscopic treatment for endometriosis. All revised American Fertility Society stages were included. MEASUREMENTS AND MAIN RESULTS QOL was evaluated using the 36-Item Short Form Survey questionnaire. Factors influencing changes for each 36-Item Shorty Form Survey domain score between t0 (before surgery) and 1 year after surgery were predicted on the basis of univariate and multivariable analyses. The effect size (ES) method was used to measure changes in QOL. Univariate analysis revealed that 47% of stage IV endometriosis patients presented an improvement in the postoperative Physical Component Summary (PCS) score (ES ≥ 0.8) versus 26%, 31.3%, and 27.5% of patients with stage I, II, and III, respectively (p <.001). Forty-four percent and 38% of patients with chronic pelvic pain (CPP) presented an improvement in postoperative PCS and Mental Component Summary scores (ES>0.8) versus 23% and 24% of patients without CPP, respectively (p <.001). Multivariable analysis (ES > 0.8 vs ES < 0) revealed that women with CPP were more likely to experience greater improvement in postoperative PCS and Mental Component Summary scores than women without CPP (relative risk [RR] = 2.7; 95% confidence interval [CI], 1.7-4.4; p <.001 and RR = 1.8; 95% CI, 1.2-2.8; p <.01, respectively). Accordingly, fertile patients were more likely to show higher rates of improvement in the postoperative PCS score than infertile patients (RR = 1.8; 95% CI, 1.1-3.1; p <.05). CONCLUSION Patients presenting with severe endometriosis and who experience higher levels of pain are more likely to show improvement in QOL after surgery. CPP is the most significant independent predictive factor for changes in QOL scores.
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Comptour A, Chauvet P, Canis M, Grémeau AS, Pouly JL, Rabischong B, Pereira B, Bourdel N. Patient Quality of Life and Symptoms after Surgical Treatment for Endometriosis. J Minim Invasive Gynecol 2019; 26:717-726. [DOI: 10.1016/j.jmig.2018.08.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/08/2018] [Accepted: 08/11/2018] [Indexed: 12/30/2022]
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Abstract
Preoperative evaluation: clinical examination, and research for associated lesions. Laparoscopic approach. Cystectomy: gold standard, conformed to the endometrioma pathophysiology (3 zones). Laser CO2 Plasmajet® vaporisation: important data lead to legitimate utilisation. Haemostasis: be patient! Use of bipolar energy sparingly. Look for other endometriotic lesions, and systematic treatment. Preoperative medical treatment not always useful. Postoperative treatment: decrease recurrence. Especially for patients with no immediate pregnancy desire.
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Poizac S, Ménager N, Tourette C, Gnisci A, Estrade JP, Agostini A. [Influencing factors on surgical duration of ovarian cystectomy by single-port access]. ACTA ACUST UNITED AC 2014; 44:78-82. [PMID: 25063484 DOI: 10.1016/j.jgyn.2014.06.007] [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: 02/07/2014] [Revised: 06/09/2014] [Accepted: 06/18/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To evaluate the factors influencing the operative duration of ovarian cystectomy by single-port access (SPA). MATERIALS AND METHODS Observational monocentric study from June 2010 to September 2012. Inclusive patients were patients with an indication of ovarian cystectomy may be done by laparoscopy. The procedures were performed by the SPA system LESS®. Factors evaluated were BMI of the patient, histological nature and size of the cyst. RESULTS We performed 54 cystectomy in 49 patients. SPA surgery was successfully completed in 53 patients. The median operative time was statistically longer for endometriotic cysts than dermoid cysts or serous-mucinous cysts (P=0.003). Cases exceeding 60minutes were significantly higher in the endometriosis group (P=0.005). There wasn't correlation found between the BMI of the patient and operative time (P=0.5). The operating time wasn't increased according to the size of the cyst (P=0.9). CONCLUSION Endometriotic cysts nature appears to be the only limiting factor of cystectomy by SPA. Further studies are needed to evaluate the factors that may limit the SPA actions.
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Affiliation(s)
- S Poizac
- Service de gynécologie obstétrique, hôpital de la Conception, université Aix-Marseille-II, boulevard Baille, 13005 Marseille, France
| | - N Ménager
- Service de gynécologie obstétrique, hôpital de la Conception, université Aix-Marseille-II, boulevard Baille, 13005 Marseille, France
| | - C Tourette
- Service de gynécologie obstétrique, hôpital de la Conception, université Aix-Marseille-II, boulevard Baille, 13005 Marseille, France
| | - A Gnisci
- Service de gynécologie obstétrique, hôpital de la Conception, université Aix-Marseille-II, boulevard Baille, 13005 Marseille, France
| | - J-P Estrade
- Service de gynécologie obstétrique, hôpital de la Conception, université Aix-Marseille-II, boulevard Baille, 13005 Marseille, France
| | - A Agostini
- Service de gynécologie obstétrique, hôpital de la Conception, université Aix-Marseille-II, boulevard Baille, 13005 Marseille, France.
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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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Rimbach S, Ulrich U, Schweppe KW. Surgical Therapy of Endometriosis: Challenges and Controversies. Geburtshilfe Frauenheilkd 2013; 73:918-923. [PMID: 24771943 DOI: 10.1055/s-0033-1350890] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Revised: 09/04/2013] [Accepted: 09/04/2013] [Indexed: 02/07/2023] Open
Abstract
Endometriosis is one of the most common disorders encountered in surgical gynaecology. The laparoscopic technique, the planning of the surgical intervention, the extent of information provided to patients and the interdisciplinary coordination make it a challenging intervention. Complete resection of all visible foci of disease offers the best control of symptoms. However, the possibility of achieving this goal is limited by the difficulty of detecting all foci and the risks associated with radical surgical strategies. Thus, the excision of ovarian endometrioma can result in a significant impairment of ovarian function, while damage to nerve structures during resection of the uterosacral ligaments, the parametrium, the rectovaginal septum or the vaginal cuff to treat deep infiltrating endometriosis can lead to serious functional impairments such as voiding disorders. A detailed risk-benefit analysis is therefore necessary, and patients must be treated using an individual approach.
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Affiliation(s)
- S Rimbach
- Gynäkologie und Geburtshilfe, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - U Ulrich
- Klinik für Gynäkologie und Geburtshilfe, Martin-Luther-Krankenhaus, Berlin
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Deb S, Sahu B, Deen S, Newman C, Powell M. Comparison of tissue effects quantified histologically between PlasmaJet coagulator and Helica thermal coagulator. Arch Gynecol Obstet 2012; 286:399-402. [DOI: 10.1007/s00404-012-2302-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Accepted: 02/16/2012] [Indexed: 11/29/2022]
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