TY - JOUR
T1 - Recurrence Rate after “One-Step” CO2 Fiber Laser Vaporization versus Cystectomy for Ovarian Endometrioma
T2 - A 3-Year Follow-up Study
AU - Candiani, Massimo
AU - Ottolina, Jessica
AU - Schimberni, Matteo
AU - Tandoi, Iacopo
AU - Bartiromo, Ludovica
AU - Ferrari, Stefano
N1 - Publisher Copyright:
© 2019 AAGL
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/5/1
Y1 - 2020/5/1
N2 - Study Objective: To assess postoperative recurrence rates in patients with endometriomas managed by either “one-step” CO2 fiber laser vaporization or cystectomy. Design: Retrospective study with prospective recording of data. Setting: University hospital. Patients: One hundred twenty-five patients with symptomatic endometriomas. Interventions: Patients underwent a standardized laparoscopic stripping technique (group 1) or cyst vaporization with CO2 fiber laser (group 2). After surgery, patients were incorporated in a prolonged surveillance program with periodic clinical follow-up to check for recurrence of the cyst and/or recurrence of symptoms. Endometrioma recurrence was defined as an ovarian cyst (>10 mm) with a typical aspect arising on the operated ovary identified by transvaginal ultrasound. Measurements and Main Results: The primary endpoint was the comparison of recurrence rates between the 2 groups. The secondary endpoint was the evaluation of endometriosis-related pain recurrence in the 2 groups. Other endpoints selected for analysis included the identification of risk factors for the recurrence of endometrioma and of endometriosis-related symptoms. The mean follow-up was 29 ± 13 months (range, 13–49). Recurrence of ovarian endometriosis was recorded in 6.3% of patients (n = 4) treated with cystectomy and in 4.9% of patients (n = 3) managed with CO2 fiber laser (p = .74). Recurrence of endometriosis-related pain was observed in 5 patients (7.8%) in group 1 and in 6 patients (9.8%) in group 2 (p = .67). Mean endometrioma diameter > 5 cm at the time of surgery was identified as the only independent poor prognostic indicator for cyst recurrence (p = .008; odds ratio [OR], 2.21; 95% confidence interval [CI], 1.19–3.32). Moreover, the presence of deep endometriosis at surgery (p = .032; OR, 4.60; 95% CI, 1.14–18.57) and discontinuation of hormonal treatment (p = .015; OR, 3.18; 95% CI, 1.25–8.06) were independent poor prognostic indicators for pain recurrence. Conclusion: This study suggests that one-step CO2 fiber laser vaporization may be effective for endometrioma treatment because it is associated with recurrence rates comparable with those occurring after cystectomy, with the advantage of being an ovarian tissue-sparing technique.
AB - Study Objective: To assess postoperative recurrence rates in patients with endometriomas managed by either “one-step” CO2 fiber laser vaporization or cystectomy. Design: Retrospective study with prospective recording of data. Setting: University hospital. Patients: One hundred twenty-five patients with symptomatic endometriomas. Interventions: Patients underwent a standardized laparoscopic stripping technique (group 1) or cyst vaporization with CO2 fiber laser (group 2). After surgery, patients were incorporated in a prolonged surveillance program with periodic clinical follow-up to check for recurrence of the cyst and/or recurrence of symptoms. Endometrioma recurrence was defined as an ovarian cyst (>10 mm) with a typical aspect arising on the operated ovary identified by transvaginal ultrasound. Measurements and Main Results: The primary endpoint was the comparison of recurrence rates between the 2 groups. The secondary endpoint was the evaluation of endometriosis-related pain recurrence in the 2 groups. Other endpoints selected for analysis included the identification of risk factors for the recurrence of endometrioma and of endometriosis-related symptoms. The mean follow-up was 29 ± 13 months (range, 13–49). Recurrence of ovarian endometriosis was recorded in 6.3% of patients (n = 4) treated with cystectomy and in 4.9% of patients (n = 3) managed with CO2 fiber laser (p = .74). Recurrence of endometriosis-related pain was observed in 5 patients (7.8%) in group 1 and in 6 patients (9.8%) in group 2 (p = .67). Mean endometrioma diameter > 5 cm at the time of surgery was identified as the only independent poor prognostic indicator for cyst recurrence (p = .008; odds ratio [OR], 2.21; 95% confidence interval [CI], 1.19–3.32). Moreover, the presence of deep endometriosis at surgery (p = .032; OR, 4.60; 95% CI, 1.14–18.57) and discontinuation of hormonal treatment (p = .015; OR, 3.18; 95% CI, 1.25–8.06) were independent poor prognostic indicators for pain recurrence. Conclusion: This study suggests that one-step CO2 fiber laser vaporization may be effective for endometrioma treatment because it is associated with recurrence rates comparable with those occurring after cystectomy, with the advantage of being an ovarian tissue-sparing technique.
KW - CO fiber laser
KW - Cystectomy
KW - Endometrioma
KW - Recurrences
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U2 - 10.1016/j.jmig.2019.07.027
DO - 10.1016/j.jmig.2019.07.027
M3 - Article
C2 - 31377455
AN - SCOPUS:85071493430
VL - 27
SP - 901
EP - 908
JO - Journal of Minimally Invasive Gynecology
JF - Journal of Minimally Invasive Gynecology
SN - 1553-4650
IS - 4
ER -