Obstet Gynecol Sci.  2016 Jul;59(4):286-294. 10.5468/ogs.2016.59.4.286.

Preoperative risk factors in recurrent endometrioma after primary conservative surgery

• Chon SJ
• Lee SH
• Choi JH
• Lee JS

• KMID: 2329049
• DOI: http://doi.org/10.5468/ogs.2016.59.4.286

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.

Keyword

Endometriosis; Preoperative; Recurrence; Septation; Ultrasonography

MeSH Terms

Ambulatory Care Facilities
Dysmenorrhea
Endometriosis*
Female
Humans
Multivariate Analysis
Parity
Recurrence
Retrospective Studies
Risk Factors*
Stromal Cells
Ultrasonography

Figure

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  Fig. 1 Cumulative recurrent free survival according to presence of septation within endometrioma in cases with recurrent endometrioma. People having inner cystic septation was associated with recurrence within shorter period of time (log rank, P=0.003) than people without septation.

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  Fig. 2 Cumulative recurrent free survival according to presence of nodularity within endometrioma in cases with recurrent endometrioma. People with and without inner cystic nodularity had no difference in duration of recurrence since 1st operation (log rank, P=0.726).

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