Efficacité et tolérance du traitement des nodules d’endométriose de la paroi abdominale cryoablation per cutanée versus chirurgie : étude comparative

Purpose: to evaluate the tolerance, efficacy and outcomes of percutaneous image-guided cryoablation vs surgical resection of localized symptomatic abdominal wall endometriosis. Patients and Methods: after a retrospective review of a single institution database, a total of 7 patients (15 lesions ; mean age 36,1 years) were included in the cryoablation group while 13 patients (16 lesions ; mean age 31.9 years) were included in the surgical group. The main information recorded was age, antecedents, tumor and procedure characteristics, severe complications (≥ grade 3 according to the CTCAE classification). Results: the mean follow up was of 1.7 years (range 3-42 months) for the cryoablation group and 4.5 years (14-149 months) for the surgical group. The mean node size was 2,3cm and 2,5 cm respectively. Cryoablation was performed in a single session under general anesthesia for 4 patients (57%) and local anesthesia for 3 patients (43%). Surgery was performed under general anesthesia in all patients but one (92%). The mean procedure and hospitalization lengths were 41.5 minutes (24-66) and 0.8 day for the cryoablation group, respectively. For the surgical group, they were 73,5 minutes (35- 160), and 2.8 days (1-12 days). Postoperative superficial edema disappeared within 2 weeks for all patients treated by cryoablation. After cryoablation, the mean postoperative pain was 2 at 6 months (0-8) and MRI demonstrated a significant volume decrease and a partiel reduction on RECIST for all patients. No severe complications were reported in the cryoablation group whereas in the surgical group, 3 severe adverse effects occurred, 9 patients had esthetic sequelaes. Conclusions: percutaneous image-guided cryoablation appears to be safe and effective for local control of symptomatic wall endometriosis, with a shortened procedure and hospitalisation compared with surgery, no complication, no esthetic sequelae were observed.