Balancing ovarian preservation and recurrence risk: A systematic review and meta-analysis of cystectomy versus ablative methods in endometrioma management

Paola Romeo, A. Tassone, L. Bonanno, G. Vizzielli, S. Restaino, C. Ronsini, V Chiantera, R. Granese, S. Cianci
In: European Journal of Obstetrics & Gynecology and Reproductive Biology · 2026 · vol. 325 , pp. 115288 · doi:10.1016/j.ejogrb.2026.115288 · PMID:42424709 · W7167517914
review OA: closed CC0
View on OpenAlex View on PubMed View at publisher
⚙ AI-generated summary by claude@2026-07, 2026-07-08 ⓘ

This systematic review and meta-analysis compared cystectomy to ablative methods for endometrioma management, examining outcomes related to ovarian preservation and recurrence risk.

One-sentence paraphrase of the abstract; not a substitute for reading it. No clinical advice. How this works

Abstract

ObjectiveTo compare cystectomy and ablative surgical techniques for the treatment of ovarian endometrioma, focusing on recurrence, ovarian reserve, and fertility outcomes.MethodsThis systematic review and meta-analysis was conducted according to PRISMA 2020 guidelines and prospectively registered in PROSPERO (CRD420261342497). PubMed and Scopus were searched from January 2000 to September 2025. Studies comparing cystectomy with ablative techniques (CO2 laser, argon plasma coagulation, PlasmaJet, bipolar energy, or hybrid approaches) in women with ovarian endometrioma ≥3 cm were included. Random-effects models were used to calculate pooled risk ratios (RRs) for dichotomous outcomes and mean differences (MDs) for continuous outcomes.ResultsTwelve studies were included, with 4-6 studies contributing to each meta-analysis depending on outcome availability. Cystectomy showed a trend toward lower recurrence compared with ablative techniques (RR 0.61, 95% CI 0.37-1.01; p = 0.054), although this did not reach statistical significance. Ablative techniques were associated with better preservation of ovarian reserve, with a significantly smaller decline in antral follicle count (MD - 1.96, 95% CI - 3.04 to - 0.88; p < 0.001), while no significant difference was observed in anti-Müllerian hormone levels (MD - 0.24, 95% CI - 0.69 to 0.21; p = 0.30). No significant differences were found in overall pregnancy (RR 1.02), spontaneous conception (RR 1.02), or ART/IVF pregnancy rates (RR 0.83).ConclusionCystectomy may reduce recurrence risk, whereas ablative techniques better preserve ovarian reserve. However, neither approach appears to confer a significant advantage in fertility outcomes. Surgical management of ovarian endometrioma should be individualized based on patient characteristics and reproductive goals.

My notes (saved in your browser only)

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (35)

SciLite annotations

chemicals 1
argon

Source provenance

openalex
last seen: 2026-08-01T06:00:24.223380+00:00
scilite
last seen: 2026-07-19T09:54:07.271699+00:00
License: CC0 · commercial use OK