1
|
Marcelin C, Maas P, Jambon E, Maaloum R, Andreo IM, Le Bras Y, Roman H, Grenier N, Brun JL, Cornelis FH. Long-term outcomes after percutaneous cryoablation of abdominal wall endometriosis. Eur Radiol 2024:10.1007/s00330-024-10689-5. [PMID: 38512491 DOI: 10.1007/s00330-024-10689-5] [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: 10/18/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVE To retrospectively evaluate the long-term outcomes after percutaneous cryoablation of abdominal wall endometriosis (AWE). METHOD The Institutional Review Board approved this retrospective observational review of 40 consecutive patients, of a median age of 37 years (interquartile range [IQR] 32-40 years), presenting with a total of 52 symptomatic AWE nodules. All patients underwent cryoablation between January 2013 and May 2022 with a minimum follow-up period of 12 months. Outcomes were assessed using a visual analog scale (VAS) that measured pain, as well as by magnetic resonance imaging (MRI). The pain-free survival rates were derived using the Kaplan-Meier estimator. Adverse events were analyzed and graded using the classification system of the Cardiovascular and Interventional Radiological Society of Europe. RESULTS The median follow-up time was 40.5 months (IQR 26.5-47.2 months). The median VAS score before cryoablation was 8 (IQR 7-9). Complete relief of symptoms was documented in 80% (32/40) of patients at 3 months after initial cryoablation and correlated with the absence of residual endometriosis nodules on MRI. The median pain-free survival rates were 89.2% [95% CI, 70.1-96.4%] at 36 months and 76.8% [95% CI, 55.3-83.8%] after 60 months. No patient or lesion characteristics were found to be prognostic of failure. No major adverse events or side effects were reported in long term. CONCLUSION Cryoablation safely and effectively afforded long-term pain relief for patients with AWE nodules. CLINICAL RELEVANCE STATEMENT AWE cryoablation was found to be safe and effective in the long-term. KEY POINTS • Cryoablation is highly effective with 80% of patients experiencing complete relief of AWE symptoms after a single procedure. • Cryoablation is safe without long-term adverse events or side effects. • The median pain-free survival rates are 89.2% at 36 months and 76.8% at 60 months.
Collapse
Affiliation(s)
- Clément Marcelin
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Service d'imagerie diagnostique et thérapeutique de l'adulte, 3300, Bordeaux, France.
- Université de Bordeaux, INSERM, Bordeaux Institute of Oncology, BRIC U1312, 33000, Bordeaux, France.
| | - Philippe Maas
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Service d'imagerie diagnostique et thérapeutique de l'adulte, 3300, Bordeaux, France
| | - Eva Jambon
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Service d'imagerie diagnostique et thérapeutique de l'adulte, 3300, Bordeaux, France
| | - Rim Maaloum
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Service d'imagerie diagnostique et thérapeutique de l'adulte, 3300, Bordeaux, France
| | - Isabelle Molina Andreo
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Service d'imagerie diagnostique et thérapeutique de l'adulte, 3300, Bordeaux, France
| | - Yann Le Bras
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Service d'imagerie diagnostique et thérapeutique de l'adulte, 3300, Bordeaux, France
| | - Horace Roman
- Clinique Tivoli- Ducos, Institut Franco-Européen Multidisciplinaire d'Endométriose (IFEMEndo), 33000, Bordeaux, France
| | - Nicolas Grenier
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Service d'imagerie diagnostique et thérapeutique de l'adulte, 3300, Bordeaux, France
| | - Jean-Luc Brun
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Service de gynécologie, 33000, Bordeaux, France
| | - Francois H Cornelis
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
- Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10065, USA
| |
Collapse
|
2
|
Bachour R, Sengmanivong N, Vidal F, Goumarre C, Lapègue F, Destombes L, Gandois HC, Gac YTL, Chantalat E, Capdet J, Blais D, Guenego A, Sans N, Bilfeld MF. Percutaneous cryoablation of abdominal wall endometriosis: An analysis of 38 patients. Diagn Interv Imaging 2024:S2211-5684(24)00045-7. [PMID: 38467523 DOI: 10.1016/j.diii.2024.02.010] [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: 11/30/2023] [Revised: 02/20/2024] [Accepted: 02/21/2024] [Indexed: 03/13/2024]
Abstract
PURPOSE The purpose of this study was to evaluate the efficacy of percutaneous cryoablation in the treatment of abdominal wall endometriosis (AWE) nodules. MATERIALS AND METHODS Thirty-eight women treated for symptomatic AWE nodules with percutaneous cryoablation under ultrasound and computed tomography (CT) guidance between May 2020 and July 2023 were retrospectively included. Pain was estimated using visual analog scale (VAS) and assessed at baseline, three months, six months, and 12 months after percutaneous cryoablation. Baseline VAS score, volume of AWE nodule and magnetic resonance imaging (MRI) features of AWE nodules were compared to those obtained after percutaneous cryoablation. Major complications, if any, were noted. RESULTS Thirty-eight women with a median age of 35.5 years (interquartile range [IQR]: 32, 39; range: 24-48 years) and a total of 60 AWE nodules were treated. Percutaneous cryoablation was performed under local or regional anesthesia in 30 women (30/38; 79%). Significant decreases between initial median VAS score (7; IQR: 6, 8; range: 3-10) and median VAS score after treatment at three months (0; IQR: 0, 5; range; 0-8) (P < 0.001), six months (0; IQR: 0, 1; range; 0-10) (P < 0.001) and 12 months (0; IQR: 0, 2; range: 0-7) (P < 0.001) were observed. Percutaneous cryoablation resulted in effective pain relief in 31 out of 38 women (82%) at six months and 15 out of 18 women (83%) at 12 months. Contrast-enhanced MRI at six-month follow-up showed a significant decrease in the volume of AWE nodules and the absence of AWE nodule enhancement after treatment by comparison with baseline MRI (P < 0.001). No major complications were reported. CONCLUSION Percutaneous cryoablation is an effective, minimally invasive intervention for the treatment of AWE nodules that conveys minimal or no morbidity.
Collapse
Affiliation(s)
- Rafy Bachour
- Department of Radiology, CHU Toulouse-Purpan Cedex 9, 31059 Toulouse, France.
| | | | - Fabien Vidal
- Department of Gynecology, Clinique la Croix du Sud, 31130 Quint-Fonsegrives, France
| | - Céline Goumarre
- Department of Radiology, CHU Toulouse-Purpan Cedex 9, 31059 Toulouse, France
| | - Franck Lapègue
- Department of Radiology, CHU Toulouse-Purpan Cedex 9, 31059 Toulouse, France
| | - Louise Destombes
- Department of Radiology, CHU Toulouse-Purpan Cedex 9, 31059 Toulouse, France
| | | | - Yann Tanguy Le Gac
- Department of Gynecology, CHU Toulouse-Purpan Cedex 9, 31059 Toulouse, France
| | - Elodie Chantalat
- Department of Gynecology, CHU Toulouse-Rangueil Cedex 9, 31059 Toulouse, France
| | - Jérome Capdet
- Department of Gynecology Department, Clinique Rive Gauche, 31300 Toulouse, France
| | - Donatien Blais
- Department of Gynecology Department, Clinique Rive Gauche, 31300 Toulouse, France
| | - Adrien Guenego
- Department of Interventional Neuroradiology Hôpital Universitaire de Bruxelles (HUB), Brussels, Belgium
| | - Nicolas Sans
- Department of Radiology, CHU Toulouse-Purpan Cedex 9, 31059 Toulouse, France
| | | |
Collapse
|
3
|
Christina NM, Candrawinata VS, Lie H, Godam KI. Abdominal wall endometriosis (AWE): Two case reports and literature review. Int J Surg Case Rep 2023; 109:108495. [PMID: 37459697 PMCID: PMC10384551 DOI: 10.1016/j.ijscr.2023.108495] [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: 05/27/2023] [Revised: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 08/01/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Endometriosis is one of the most frequent gynecologic disorders, clinically confirmed or suspected in one of nine women by the age of 44 years. Its location of occurrence can be classified into intra and extra pelvic. Abdominal wall endometriosis (AWE) is one of its rare location, with frequency of 0.04 to 5.5 %. Furthermore there are only a few cases of AWE in Indonesia that have been reported. CASE PRESENTATION Here we present two Indonesian patients at a General Hospital in Tangerang, Indonesia. The first patient, 26 years old, complained of an umbilical mass 2 years after caesarean section. The second patient, 36 years old, complained of an umbilical mass since 8 months, with no history of prior surgery. Both patients had pre-operative ultrasonography (US) and underwent wide local excision. Histopathology examination with presence of endometrial glandular components and endometrial-like stroma confirmed the diagnosis of AWE. CLINICAL DISCUSSION AWE is defined as any endometrial tissue found superficial to the peritoneum, locating most commonly at umbilical, inguinal area, and anterior abdominal wall. Pre-operative diagnostic tools include abdominal ultrasonography (US) or abdominopelvic computed tomography (CT) scan. Since treatment with medications is usually not effective, surgical treatment is recommended, along with confirmation by histopathological examination. CONCLUSION Diagnosis of AWE should be suspected in all women with symptoms of an abdominal mass and cyclic pain, especially if the patient had history of surgery at the abdominal region. AWE is quite rare, but its symptoms can affect quality of life. Hence, a multi-disciplinary approach is necessary, with the strongly recommended treatment of wide local excision to prevent recurrence and malignant transformation.
Collapse
Affiliation(s)
- Natalia Maria Christina
- Department of Surgery, Faculty of Medicine, Pelita Harapan University, Siloam General Hospital, Tangerang, Indonesia
| | | | - Hendry Lie
- Department of Surgery, Faculty of Medicine, Pelita Harapan University, Tangerang, Indonesia
| | | |
Collapse
|
4
|
Grove TN, Bainton T, Celentano V, Raza A, Warren O. Excision of anterior abdominal wall endometriotic nodule and reconstruction-A video vignette. Colorectal Dis 2022; 25:814-815. [PMID: 36300692 DOI: 10.1111/codi.16390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/05/2022] [Accepted: 10/08/2022] [Indexed: 02/08/2023]
Affiliation(s)
- Thomas N Grove
- Chelsea and Westminster Hospital, London, UK.,Imperial College London, London, UK
| | - Thomas Bainton
- Chelsea and Westminster Hospital, London, UK.,Imperial College London, London, UK
| | | | - Amer Raza
- Chelsea and Westminster Hospital, London, UK.,Imperial College London, London, UK
| | - Oliver Warren
- Chelsea and Westminster Hospital, London, UK.,Imperial College London, London, UK
| |
Collapse
|
5
|
Benedetto C, Cacozza D, de Sousa Costa D, Coloma Cruz A, Tessmann Zomer M, Cosma S, Trippia CH, Santos Cavalcanti TC, Alves Castro GR, Kondo W. Abdominal wall endometriosis: Report of 83 cases. Int J Gynaecol Obstet 2022; 159:530-536. [PMID: 35246836 DOI: 10.1002/ijgo.14167] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 02/20/2022] [Accepted: 02/25/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate the clinical course and management of abdominal wall endometriosis (AWE). METHODS A retrospective study was carried out from January 2010 to December 2020, at Vita-Nações Hospitals, Curitiba, Brazil, in order to evaluate data of patients undergoing surgery for the excision of AWE. RESULTS 83 women with AWE were included in the study. Umbilical scar endometriosis was found in 26 patients (31.3%), being primary in 20 cases (76.9%) and secondary to a laparoscopic procedure in 6 cases (23.1%). 2 patients had secondary implants outside the umbilicus after laparoscopic surgery. Secondary implant after cesarian section in 55 patients (66.3%). Diagnosis was made by ultrasound in 65 patients (78.3%) and by MRI in the remaining 18 (21.7%). Complete excision of the nodule was carried out and no case of recurrence was registered up to now. CONCLUSIONS Painful abdominal mass presenting in women, especially with a previous history of abdominal and pelvic surgery, should be suspected of AWE. It occurs most often secondary to obstetric or gynecological surgeries and seems to be related to iatrogenic transfer of the endometrial tissue at the level of the surgical scar. Cesarean scar endometriosis is the most common presentation. Surgical excision including the surrounding fibrotic tissue should be performed.
Collapse
Affiliation(s)
- Chiara Benedetto
- Obstetrics and Gynecology 1U, Department of Surgical Sciences, Sant'Anna Hospital, University of Torino, Torino, Italy
| | - Daniel Cacozza
- Obstetrics and Gynecology 1U, Department of Surgical Sciences, Sant'Anna Hospital, University of Torino, Torino, Italy
| | | | - Arantxa Coloma Cruz
- Department of Gynecological Surgery, Vita Batel Hospital, Curitiba, Paraná, Brazil
| | | | - Stefano Cosma
- Obstetrics and Gynecology 1U, Department of Surgical Sciences, Sant'Anna Hospital, University of Torino, Torino, Italy
| | | | | | | | - William Kondo
- Department of Gynecological Surgery, Vita Batel Hospital, Curitiba, Paraná, Brazil
| |
Collapse
|
6
|
Allen SE, Rindos NB, Mansuria S. Abdominal wall endometriosis: an update in diagnosis, perioperative considerations and management. Curr Opin Obstet Gynecol 2021; 33:288-295. [PMID: 34054100 DOI: 10.1097/gco.0000000000000714] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
PURPOSE OF REVIEW Abdominal wall endometriosis (AWE) is rare with limited evidence guiding diagnosis and treatment. The purpose of this review is to provide an update of the diagnosis, perioperative considerations, and treatment of AWE. RECENT FINDINGS Recent studies further characterize presenting symptoms and locations of AWE. Prior abdominal surgery remains the greatest risk factor for the development of AWE. Newer evidence suggests that increasing BMI may also be a risk factor. Ultrasound is first-line imaging for diagnosis. Magnetic resonance image is preferred for surgical planning for deep or extensive lesions. Laparotomy with wide local excision is considered standard treatment for AWE with great success. Novel techniques in minimally invasive surgery have been described as effective for the treatment of AWE. A multidisciplinary surgical approach is often warranted for successful excision and reapproximation of skin and/or fascial defects. Noninvasive therapies including ultrasonic ablation or cryotherapy are also emerging as promising treatment strategies in select patients. SUMMARY Recent studies provide further evidence to guide diagnosis through physical exam and imaging as well as pretreatment planning. Treatment options for AWE are rapidly expanding with novel approaches in minimally invasive and noninvasive therapies now available.
Collapse
Affiliation(s)
- Sarah E Allen
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC, Pittsburgh, Pennsylvania, USA
| | | | | |
Collapse
|