Recurrence Rate after “One-Step” CO2 Fiber Laser Vaporization versus Cystectomy for Ovarian Endometrioma: A 3-Year Follow-up Study

Massimo Candiani, Jessica Ottolina, Matteo Schimberni, Tandoi I, Iacopo Tandoi, Ludovica Bartiromo, Stefano Ferrari, Ferrari S
Journal of Minimally Invasive Gynecology · 2019 · vol. 27(4) , pp. 901–908 · doi:10.1016/j.jmig.2019.07.027 · PMID:31377455 · W2966797350
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This 3-year follow-up study compared CO2 fiber laser vaporization and cystectomy for ovarian endometrioma and found similar recurrence rates between the two surgical approaches.

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Abstract

Study objectiveTo assess postoperative recurrence rates in patients with endometriomas managed by either "one-step" CO2 fiber laser vaporization or cystectomy.DesignRetrospective study with prospective recording of data.SettingUniversity hospital.PatientsOne hundred twenty-five patients with symptomatic endometriomas.InterventionsPatients 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 resultsThe 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.ConclusionThis 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.

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Condition tags

endometriosisendometrioma

MeSH descriptors

Endometriosis Endometriosis Endometriosis Laparoscopy Laser Therapy Laser Therapy Ovarian Cysts Ovarian Cysts Ovarian Diseases Ovarian Diseases Ovarian Diseases Carbon Dioxide Cystectomy Female Follow-Up Studies Humans Pain Pain Prospective Studies Recurrence

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