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Holdsworth-Carson SJ, Chung J, Machalek DA, Li R, Jun BK, Griffiths MJ, Churchill M, McCaughey T, Nisbet D, Dior U, Donoghue JF, Montgomery GW, Reddington C, Girling JE, Healey M, Rogers PAW. Predicting disease recurrence in patients with endometriosis: an observational study. BMC Med 2024; 22:320. [PMID: 39113136 PMCID: PMC11304583 DOI: 10.1186/s12916-024-03508-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 07/01/2024] [Indexed: 08/11/2024] Open
Abstract
BACKGROUND Despite surgical and pharmacological interventions, endometriosis can recur. Reliable information regarding risk of recurrence following a first diagnosis is scant. The aim of this study was to examine clinical and survey data in the setting of disease recurrence to identify predictors of risk of endometriosis recurrence. METHODS This observational study reviewed data from 794 patients having surgery for pelvic pain or endometriosis. Patients were stratified into two analytic groups based on self-reported or surgically confirmed recurrent endometriosis. Statistical analyses included univariate, followed by multivariate logistic regression to identify risk factors of recurrence, with least absolute shrinkage and selection operator (Lasso) regularisation. Risk-calibrated Supersparse Linear Integer Models (RiskSLIM) and survival analyses (with Lasso) were undertaken to identify predictive features of recurrence. RESULTS Several significant features were repeatedly identified in association with recurrence, including adhesions, high rASRM score, deep disease, bowel lesions, adenomyosis, emergency room attendance for pelvic pain, younger age at menarche, higher gravidity, high blood pressure and older age. In the surgically confirmed group, with a score of 5, the RiskSLIM method was able to predict the risk of recurrence (compared to a single diagnosis) at 95.3% and included adenomyosis and adhesions in the model. Survival analysis further highlighted bowel lesions, adhesions and adenomyosis. CONCLUSIONS Following an initial diagnosis of endometriosis, clinical decision-making regarding disease management should take into consideration the presence of bowel lesions, adhesions and adenomyosis, which increase the risk of endometriosis recurrence.
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Affiliation(s)
- Sarah J Holdsworth-Carson
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne and Gynaecology Research Centre, Royal Women's Hospital, Grattan St & Flemington Rd, Parkville, VIC, 3052, Australia.
- The Julia Argyrou Endometriosis Centre, Epworth HealthCare, Ground Floor, 185-187 Hoddle Street, Richmond, VIC, 3121, Australia.
| | - Jessica Chung
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne and Gynaecology Research Centre, Royal Women's Hospital, Grattan St & Flemington Rd, Parkville, VIC, 3052, Australia
- Melbourne Bioinformatics, University of Melbourne, 21 Bedford St, North Melbourne, VIC, 3051, Australia
| | - Dorothy A Machalek
- The Kirby Institute, University of New South Wales, High Street, Kensington, NSW, 2052, Australia
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Grattan St & Flemington Rd, Parkville, VIC, 3052, Australia
| | - Rebecca Li
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne and Gynaecology Research Centre, Royal Women's Hospital, Grattan St & Flemington Rd, Parkville, VIC, 3052, Australia
| | - Byung Kyu Jun
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne and Gynaecology Research Centre, Royal Women's Hospital, Grattan St & Flemington Rd, Parkville, VIC, 3052, Australia
| | - Meaghan J Griffiths
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne and Gynaecology Research Centre, Royal Women's Hospital, Grattan St & Flemington Rd, Parkville, VIC, 3052, Australia
| | - Molly Churchill
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne and Gynaecology Research Centre, Royal Women's Hospital, Grattan St & Flemington Rd, Parkville, VIC, 3052, Australia
| | - Tristan McCaughey
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne and Gynaecology Research Centre, Royal Women's Hospital, Grattan St & Flemington Rd, Parkville, VIC, 3052, Australia
| | - Debbie Nisbet
- Ultrasound Services, Royal Women's Hospital, Grattan St & Flemington Rd, Parkville, VIC, 3052, Australia
- Department of Radiology, University of Melbourne, Royal Melbourne Hospital, Royal Parade, Parkville, VIC, 3050, Australia
| | - Uri Dior
- Faculty of Medicine, Department of Obstetrics and Gynaecology, Hadassah Medical Center, P.O Box 12000, Jerusalem, 91120, Israel
| | - Jacqueline F Donoghue
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne and Gynaecology Research Centre, Royal Women's Hospital, Grattan St & Flemington Rd, Parkville, VIC, 3052, Australia
| | - Grant W Montgomery
- Institute for Molecular Bioscience, University of Queensland, 306 Carmody Road, St Lucia, Brisbane, QLD, 4072, Australia
| | - Charlotte Reddington
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne and Gynaecology Research Centre, Royal Women's Hospital, Grattan St & Flemington Rd, Parkville, VIC, 3052, Australia
| | - Jane E Girling
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne and Gynaecology Research Centre, Royal Women's Hospital, Grattan St & Flemington Rd, Parkville, VIC, 3052, Australia
- Department of Anatomy, School of Biomedical Sciences, University of Otago, 270 Great King Street, Dunedin, 9016, New Zealand
| | - Martin Healey
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne and Gynaecology Research Centre, Royal Women's Hospital, Grattan St & Flemington Rd, Parkville, VIC, 3052, Australia
- The Julia Argyrou Endometriosis Centre, Epworth HealthCare, Ground Floor, 185-187 Hoddle Street, Richmond, VIC, 3121, Australia
| | - Peter A W Rogers
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne and Gynaecology Research Centre, Royal Women's Hospital, Grattan St & Flemington Rd, Parkville, VIC, 3052, Australia
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Jago CA, Nguyen DB, Flaxman TE, Singh SS. Bowel surgery for endometriosis: A practical look at short- and long-term complications. Best Pract Res Clin Obstet Gynaecol 2020; 71:144-160. [PMID: 32680784 DOI: 10.1016/j.bpobgyn.2020.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/04/2020] [Indexed: 02/06/2023]
Abstract
Endometriosis involving the bowel requires a thorough evaluation prior to deciding upon surgical treatment. Patient symptoms, treatment goals, extent and location of disease, surgeon experience, and anticipated risks all play a part in the preoperative decision-making process. Short- and long-term complications after bowel surgery for endometriosis are the focus of this article. Unfortunately, the literature to date has inherent limitations that prevent generalizability. Most studies are retrospective or prospective single-center case series. Publication bias is unavoidable with mainly large volume experts sharing their experience. As a result, there is a need for high-quality prospective studies that standardize inclusion criteria and outcome measures among various centers with an aim to present long-term outcomes. In the meantime, care for those with endometriosis involving the bowel requires a thorough preoperative plan to minimize risks and a need for early diagnosis and management of complications unique to bowel surgery.
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Affiliation(s)
- Caitlin Anne Jago
- Minimally Invasive Gynecology Research Group, Department of Ob/Gyn and Newborn Care, University of Ottawa & the Ottawa Hospital, 501 Smyth Rd, K1H 8L6, Ottawa ON Canada
| | - Dong Bach Nguyen
- Minimally Invasive Gynecology Research Group, Department of Ob/Gyn and Newborn Care, University of Ottawa & the Ottawa Hospital, 501 Smyth Rd, K1H 8L6, Ottawa ON Canada
| | - Teresa E Flaxman
- Minimally Invasive Gynecology Research Group, Department of Ob/Gyn and Newborn Care, University of Ottawa & the Ottawa Hospital, 501 Smyth Rd, K1H 8L6, Ottawa ON Canada; Ottawa Hospital Research Institute, Department of Clinical Epidemiology, 1053 Carling Ave, K1Y 4E9, Ottawa ON Canada
| | - Sukhbir S Singh
- Minimally Invasive Gynecology Research Group, Department of Ob/Gyn and Newborn Care, University of Ottawa & the Ottawa Hospital, 501 Smyth Rd, K1H 8L6, Ottawa ON Canada; Ottawa Hospital Research Institute, Department of Clinical Epidemiology, 1053 Carling Ave, K1Y 4E9, Ottawa ON Canada.
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