{"paper_id":"ee3c8232-c4c8-4c12-bc13-0fede2124993","body_text":"Abstract\nObjectives\nTo compare the outcomes of percutaneous image-guided cryoablation of symptomatic abdominal wall endometriosis (AWE) versus surgery alone.\nMethods\nFrom 2004 to 2016, cryoablation or surgery alone was performed under local (n = 5) or general anaesthesia (n = 15) for AWE in a single institution in 7 (mean age, 36.1 years) and 13 (mean age, 31.9 years) patients, respectively. Fifteen lesions were treated by cryoablation (mean size, 2.3 cm; range, 0.5-7 cm) and 16 by surgery (2.5 cm; 1.1-3.4 cm). Tolerance, efficacy and patient and procedural characteristics were compared.\nResults\nMedian follow-up was 22.5 (range, 6-42) months after cryoablation and 54 (14-149) after surgery. The median procedure and hospitalisation durations were 41.5 min (24-66) and 0.8 days (0-1) after cryoablation, and 73.5 min (35-160) and 2.8 days (1-12 days) after surgery (both P = 0.01). Three patients (23.1%) had severe complications and nine aesthetic sequels (69.2%) after surgery, none after cryoablation (P = 0.05). The median 12- and 24-month symptom free-survival rates were 100% and 66.7% (95% CI, 5.4; 94.5) after cryoablation and 92% (55.3; 98.9) after surgery at both time points (P = 0.45).\nConclusions\nCryoablation presents similar effectiveness to surgery alone for local control of AWE while reducing hospitalisation duration and complications. Any aesthetic sequels were associated with the cryoablation treatment.\nKey points\n• Hospitalisation is shorter after cryoablation than after surgery of abdominal wall endometriosis.\n• A significantly lower rate of complications is observed after cryoablation compared to surgery.\n• Cryoablation of abdominal wall endometriosis presents similar effectiveness to surgery alone.\n• A significant reduction of pain is observed 6 months after treatment.\n• A significant reduction of abdominal wall endometriosis is observed at 6 months.\nSimilar content being viewed by others\nReferences\nHorton JD, Dezee KJ, Ahnfeldt EP, Wagner M (2008) Abdominal wall endometriosis: a surgeon’s perspective and review of 445 cases. Am J Surg 196:207–212\nHensen JH, Van Breda Vriesman AC, Puylaert JB (2006) Abdominal wall endometriosis: clinical presentation and imaging features with emphasis on sonography. AJR Am J Roentgenol 186:616–620\nErkan N, Haciyanli M, Sayhan H (2005) Abdominal wall endometriomas. Int J Gynaecol Obstet 89:59–60\nPicod G, Boulanger L, Bounoua F et al (2006) Abdominal wall endometriosis after caesarean section: report of fifteen cases. Gynecol Obstet Fertil 34:8–13\nPatterson GK, Winburn GB (1999) Abdominal wall endometriomas: report of eight cases. Am Surg 65:36–39\nRousset P, Gregory J, Rousset-Jablonski C et al (2016) MR diagnosis of diaphragmatic endometriosis. Eur Radiol 26:3968–3977\nBusard MPH, Mijatovic V, van Kuijk C et al (2010) Appearance of abdominal wall endometriosis on MR imaging. Eur Radiol 20:1267–1276\nKinkel K, Frei KA, Balleyguier C, Chapron C (2006) Diagnosis of endometriosis with imaging: a review. Eur Radiol 16:285–298\nSeydel AS, Sickel JZ, Warner ED, Sax HC (1996) Extrapelvic endometriosis: diagnosis and treatment. Am J Surg 171:239\nKoger KE, Shatney CH, Hodge K, McClenathan JH (1993) Surgical scar endometrioma. Surg Gynecol Obstet 177:243–246\nMatthes G, Zabel DD, Nastala CL, Shestak KC (1998) Endometrioma of the abdominal wall following combined abdominoplasty and hysterectomy: case report and review of the literature. Ann Plast Surg 40:672–675\nPados G, Tympanidis J, Zafrakas M et al (2008) Ultrasound and MR-imaging in preoperative evaluation of two rare cases of scar endometriosis. Cases J 1:97\nCornelis F, Havez M, Lippa N et al (2013) Radiologically guided percutaneous cryotherapy for soft tissue tumours: a promising treatment. Diagn Interv Imaging 94:364–370\nCarrafiello G, Fontana F, Pellegrino C et al (2009) Radiofrequency ablation of abdominal wall endometrioma. Cardiovasc Interv Radiol 32:1300–1303\nWang Y, Wang W, Wang L et al (2011) Ultrasound-guided high-intensity focused ultrasound treatment for abdominal wall endometriosis: preliminary results. Eur J Radiol 79:56–59\nCornelis F, Petitpierre F, Lasserre AS et al (2014) Percutaneous cryoablation of symptomatic abdominal scar endometrioma: initial reports. Cardiovasc Interv Radiol 37:1575–1579\nCornelis F, Havez M, Labrèze C et al (2013) Percutaneous cryoablation of symptomatic localized venous malformations: preliminary short-term results. J Vasc Interv Radiol 24:823–827\nKujak JL, Liu PT, Johnson GB, Callstrom MR (2010) Early experience with percutaneous cryoablation of extra-abdominal desmoid tumors. Skelet Radiol 39:175–182\nCornelis F, Italiano A, Al-Ammari S et al (2012) Successful iterative percutaneous cryoablation of multiple extraabdominal desmoid tumors in a patient with Gardner syndrome. J Vasc Interv Radiol 23:1101–1103\nHavez M, Lippa N, Al-Ammari S et al (2014) Percutaneous image-guided cryoablation in inoperable extra-abdominal desmoid tumors: a study of tolerability and efficacy. Cardiovasc Interv Radiol 37:1500–1506\nCornelis F, Neuville A, Labreze C et al (2013) Percutaneous cryotherapy of vascular malformation: initial experience. Cardiovasc Interv Radiol 36:853–856\nShaikh R, Alomari AI, Kerr CL et al (2016) Cryoablation in fibro-adipose vascular anomaly (FAVA): a minimally invasive treatment option. Pediatr Radiol 46:1179–1186\nThompson SM, Callstrom MR, McKusick MA, Woodrum DA (2015) Initial results of image-guided percutaneous ablation as second-line treatment for symptomatic vascular anomalies. Cardiovasc Interv Radiol 38:1171–1178\nCallstrom MR, Kurup AN (2009) Percutaneous ablation for bone and soft tissue metastases—why cryoablation? Skelet Radiol 38:835–839\nJanzen NK, Perry KT, Han K-RR et al (2005) The effects of intentional cryoablation and radio frequency ablation of renal tissue involving the collecting system in a porcine model. J Urol 173:1368–1374\nGoldberg SN, Grassi CJ, Cardella JF et al (2005) Image-guided tumor ablation: standardization of terminology and reporting criteria. J Vasc Interv Radiol 16:S377–S390\nEisenhauer EA, Therasse P, Bogaerts J et al (2009) New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 45:228–247\nWeld KJ, Landman J (2005) Comparison of cryoablation, radiofrequency ablation and high-intensity focused ultrasound for treating small renal tumours. BJU Int 96:1224–1229\nKurup AN, Callstrom MR (2010) Image-guided percutaneous ablation of bone and soft tissue tumors. Semin Interv Radiol 27:276–284\nTsoumakidou G, Buy X, Garnon J et al (2011) Percutaneous thermal ablation: how to protect the surrounding organs. Tech Vasc Interv Radiol 14:170–176\nLittrup PJ, Bang HJ, Currier BP et al (2013) Soft-tissue cryoablation in diffuse locations: feasibility and intermediate term outcomes. J Vasc Interv Radiol 24:1817–1825\nWeibel S, Neubert K, Jelting Y et al (2016) Incidence and severity of chronic pain after caesarean section. Eur J Anaesthesiol 33:853–865\nNominato NS, Prates LFVS, Lauar I et al (2010) Caesarean section greatly increases risk of scar endometriosis. Eur J Obstet Gynecol Reprod Biol 152:83–85\nClausen I, Nielsen KT (1987) Endometriosis in the groin. Int J Gynaecol Obstet 25:469–471\nGidwaney R, Badler RL, Yam BL et al (2012) Endometriosis of abdominal and pelvic wall scars: multimodality imaging findings, pathologic correlation, and radiologic mimics. Radiographics 32:2031–2043\nCallstrom MR, York JD, Gaba RC et al (2009) Research reporting standards for image-guided ablation of bone and soft tissue tumors. J Vasc Interv Radiol JVIR 20:1527–1540\nChu KF, Dupuy DE (2014) Thermal ablation of tumours: biological mechanisms and advances in therapy. Nat Rev Cancer 14:199–208\nAcknowledgements\nThe authors thank Pippa McKelvie-Sebileau for medical editorial services.\nAuthor information\nAuthors and Affiliations\nCorresponding author\nEthics declarations\nGuarantor\nThe scientific guarantor of this publication is Francois Cornelis.\nConflict of interest\nThe authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.\nFunding\nThe authors state that this work has not received any funding.\nStatistics and biometry\nNo complex statistical methods were necessary for this paper.\nInformed consent\nWritten informed consent was waived by the Institutional Review Board.\nEthical approval\nInstitutional Review Board approval was obtained.\nStudy subjects or cohorts overlap\nSome study subjects or cohorts (n = 4) have been previously reported in Cornelis et al. [16].\nMethodology\n• Retrospective\n• Case-control study\n• Performed at one institution\nRights and permissions\nAbout this article\nCite this article\nMaillot, J., Brun, J.L., Dubuisson, V. et al. Mid-term outcomes after percutaneous cryoablation of symptomatic abdominal wall endometriosis: comparison with surgery alone in a single institution. Eur Radiol 27, 4298–4306 (2017). https://doi.org/10.1007/s00330-017-4827-7\nReceived:\nRevised:\nAccepted:\nPublished:\nIssue date:\nDOI: https://doi.org/10.1007/s00330-017-4827-7","source_license":"CC0","license_restricted":false}