Uterus-sparing operative treatment for adenomyosis

OBJECTIVE: To review systematically the literature on uterus-sparing surgical treatment options for adenomyosis. DESIGN: Systematic literature review. SETTING: Tertiary academic center. PATIENT(S): Women with histologically proven adenomyosis treated with uterus-sparing surgical techniques. INTERVENTION(S): Conservative uterine-sparing surgery for adenomyosis classified as (1) complete excision of adenomyosis, (2) cytoreductive surgery or incomplete removal of the lesion, or (3) nonexcisional techniques, with studies selected if women with adenomyosis were treated surgically without performing hysterectomy. MAIN OUTCOME MEASURE(S): The cure rate after interventional strategies, the rate of symptom (dysmenorrhea and menorrhagia) control, and pregnancy rate in each group of intervention. RESULT(S): A quality assessment tool was used to assess the scientific value of each study. In total, 64 studies dealing with 1,049 patients were identified. After complete excision, the dysmenorrhea reduction, menorrhagia control, and pregnancy rate were 82.0%, 68.8%, and 60.5%, respectively. After partial excision, the dysmenorrhea reduction, menorrhagia control, and pregnancy rate were 81.8%, 50.0%, and 46.9%, respectively. CONCLUSION(S): Uterine-sparing operative treatment of adenomyosis and its variants appear to be feasible and efficacious. Well-designed, comparative studies are urgently needed to answer the multiple questions arising from this intriguing intervention.