Recurrence of ovarian endometrioma after second-line, conservative, laparoscopic cyst enucleation

Mi-La Kim, Mi‐La Kim, Kim ML, Joo Myoung Kim, Kim JM, Seong SJ, Seok Ju Seong, Soo Yoon Lee, Lee SY, Han M, Myoung Seok Han, Myoungseok Han, Yeon Jean Cho, Cho YJ
American journal of obstetrics and gynecology · 2013 · vol. 210(3) , pp. 216.e1–216.e6 · doi:10.1016/j.ajog.2013.11.007 · PMID:24215855 · W2034848646
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This study investigated the recurrence rate of ovarian endometrioma following a second conservative laparoscopic cyst enucleation procedure.

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Abstract

OBJECTIVE: We sought to evaluate the cumulative recurrence rate of endometrioma after a second-line, conservative, laparoscopic endometriotic cyst enucleation and to analyze the factors that influence the recurrence of endometrioma. STUDY DESIGN: A multicenter retrospective cohort study was performed at 3 gynecologic surgery centers from January 2000 through December 2010. Patients surgically treated by laparoscopic enucleation of endometriotic cysts on 2 previous occasions were selected. All patients were aged <40 years at the time of the primary surgery and were followed up for at least 6 months. Endometrioma recurrence was considered when transvaginal sonography indicated a cystic mass with a diameter of ≥20 mm. RESULTS: In total, 183 patients were followed up for 33.2 ± 27.7 months (range, 6-121 months). Thirty-eight (20.8%) patients experienced recurrence after the second-line surgery and 24 (13.1%) patients underwent a third surgery. The median time to recurrence was 24 ± 3.36 months (SEM) (range, 3-72 months). The cumulative recurrence rates per patient at 12, 24, 36, and 60 months after the second-line surgery were 7.7%, 13.7%, 21.3%, and 37.5%, respectively. After multivariate analysis and analysis of covariance, the revised American Fertility Society score and stage were significantly higher in patients who experience a third recurrence of endometrioma. CONCLUSION: The cumulative recurrence rate of ovarian endometrioma after a second-line surgery appears to be correlated to the duration of follow-up. Severe endometriosis at the second-line surgery seems to be a factor associated with a high recurrence risk. Physicians should be cautious with regard to the postoperative management of these patients.

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Condition tags

endometriosisendometrioma

MeSH descriptors

Endometriosis Neoplasm Recurrence, Local Ovarian Neoplasms Adult Adult Endometriosis Endometriosis Endometriosis Endometriosis Female Female Humans Humans Incidence Incidence Laparoscopy Laparoscopy Middle Aged Middle Aged Neoplasm Recurrence, Local

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