Beyond the pelvis: diagnostic and surgical challenges of thoracic endometriosis syndrome - a retrospective cohort study of 41 patients

Natalia Szczepańska, Przemysław Miłosz, Rafał Pęksa, Aleksandra Ciarka, Marcin Folwarski, Julia Niedzielska, Michał Szymański, Maciej Wilczyński, Tomasz Marjański
In: Frontiers in Medicine · 2026 · vol. 13 · doi:10.3389/fmed.2026.1835516 · W7162633561
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⚙ AI-generated summary by claude@2026-06, 2026-06-04 ⓘ

This study found diaphragmatic reconstruction was associated with lower recurrence rates in surgically treated thoracic endometriosis syndrome patients, and routine immunohistochemistry improved diagnosis.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-04 ⓘ

This retrospective cohort study analyzed 41 surgically treated women with thoracic endometriosis syndrome (TES) at a single tertiary thoracic surgery center (2012–2025), comparing early versus late eras to capture changes in surgical management (e.g., VATS, thoracotomy, thoracolaparoscopy) and evaluating whether diaphragmatic reconstruction was linked to lower postoperative intervention-requiring recurrence; histopathology using ER, PR, and CD10 immunohistochemistry was also tracked. Among those with complete follow-up (78.0%), intervention-requiring recurrence occurred in 0% with diaphragmatic reconstruction versus 27.3% without reconstruction, and routine immunohistochemical staining after 2022 markedly improved TES confirmation (90% vs 0%). A major caveat was differential loss to follow-up between reconstructed and non-reconstructed groups, which could bias outcome direction depending on the missing patients’ results. This paper is centrally about endometriosis — specifically thoracic endometriosis syndrome and the role of diaphragmatic reconstruction and immunohistochemical diagnosis, which is a key extrapelvic form of endometriosis.

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Abstract

Objective This study provides a comprehensive analysis of surgically managed thoracic endometriosis syndrome (TES) patients, primarily assessing whether diaphragmatic reconstruction is associated with lower postoperative recurrence. Secondarily, the study aims to evaluate histopathological findings and temporal changes in management of TES at a tertiary care center. Methods This retrospective study of 41 female patients (median age 37) treated surgically for TES between 2012 and 2025 at the Department of Thoracic Surgery, Medical University of Gdansk, Poland. Patients presenting with pneumothorax and/or symptoms of diaphragmatic endometriosis were stratified into Early and Late periods to evaluate changes in surgical management - video-assisted thoracoscopic surgery (VATS), thoracotomy, thoracolaparoscopy, and the implementation of accurate immunohistochemical histopathological assessment. Results Complete follow-up was available for 78.0% of patients, however, with differential loss to follow-up between groups (4.5% reconstruction vs. 42.1% no reconstruction; p = 0.006) may have biased results, with the direction of bias depending on the outcomes of patients lost to follow-up. Among patients with complete follow-up, intervention-requiring recurrence occurred in 0% of women with reconstruction versus 27.3% without reconstruction (Fisher exact p = 0.033). Among patients treated since 2022, diaphragmatic reconstruction was more frequent than in 2012–2021 (71.4% vs. 35.0%, p = 0.029). Routine immunohistochemical staining since 2022 improved histopathological confirmation of TES (90% vs. 0%; p < 0.001). Conclusion In the study, diaphragmatic reconstruction was associated with lower intervention-requiring recurrence, which may indicate a potential benefit of reconstructive techniques in TES surgery. Routine immunohistochemical evaluation (ER, PR, CD10) may be essential for TES diagnosis.

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endometriosisthoracic_endometriosis

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