Long-term results of organ-preserving treatment of uterine leiomyoma combined with endometriosis.

In: Medicni perspektivi (Medical perspectives) · 2018 · vol. 23(1) , pp. 63–70 · doi:10.26641/2307-0404.2018.1.124929 · W2797639742
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This study found that uterine leiomyoma recurrence after myomectomy occurred in 56.1% of patients within five years, with a significantly higher recurrence rate in women who also had endometriosis.

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The paper analyzed 5-year follow-up outcomes in 82 reproductive-age women who underwent myomectomy for uterine leiomyoma, comparing recurrence rates between those with isolated leiomyoma and those with uterine endometriosis in addition to leiomyoma. Myomectomy was performed via transabdominal, laparoscopic, or transcervical hysteroresectoscopic approaches, and the main finding was that leiomyoma recurrence occurred in 56.1% overall, with significantly higher recurrence in the combined group (71.1%) versus isolated leiomyoma (43.2%, p<0.05). The authors reported that the combined pathology showed a higher risk of recurrence particularly in the first postoperative year and overall by 5 years, and they explicitly attribute this to an additional recurrence-initiating effect of uterine endometriosis. This paper is centrally about endometriosis — it evaluates how coexisting uterine endometriosis changes long-term leiomyoma recurrence after myomectomy.

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Abstract

The analysis of a five-years’ catamnesis of reproductive age women who underwent surgery to remove leiomyoma nodes (myomectomy) is represented in this article. The aim of the study was to determine the incidence of tumor recurrence after myomectomy in women with leiomyoma combined with endometriosis. 82 operated patients, included into rescarch were divided into two groups according to the criterion of the presence or absence of endometriosis of the uterus. Group I included 44 (53.7%) cases of isolated lyomyomyoma surgery, and group II - 38 (46.3%) cases of combination of a similar tumor with endometriosis of the uterus. Myomectomy was performed by the transabdominal way in 43.9%, laparoscopic – in 46.3%, transcervical with a hysteroresectoscope - 11.4% of cases of operative treatment. According to the 5 years observation after the surgery, the recurrence of uterine leiomyoma appeared in 56.1% of women of both groups, while in group II, where the combination of uterine leiomyoma with endometriosis was noted, the frequency of tumor recurrences was significantly higher (71.1%, p<0,05%) than in group I with isolated uterine leiomyoma (43.2%,). Thus, the long-term results of myomectomy in women with uterine leiomyoma are associated with the risk of recurrence of the tumor in almost every second woman, but with the combined pathology of the uterus, these cases have a number of features compared to an isolated tumor – 2.5 times hig­her risk of recurrence in the first year after the operation and by 1.65 times higher frequency of relapse of the leio­myoma within 5 years after the surgery. The authors suggest that these differences evidence that the presence of endo­metriosis of the uterus is an additional factor that initiates the mechanisms of recurrence of the uterine leiomyoma after miomectomy, which should be taken into account in the development of a program of postoperative reproductive health rehabilitation of women with co-pathology of the uterus.
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Long-term results of organ-preserving treatment of uterine leiomyoma combined with endometriosis. DOI: https://doi.org/10.26641/2307-0404.2018.1.124929Keywords: leiomyoma in combination with endometriosis of the uterus, myomectomy, long-term operation results, tumor recurrencesAbstract The analysis of a five-years’ catamnesis of reproductive age women who underwent surgery to remove leiomyoma nodes (myomectomy) is represented in this article. The aim of the study was to determine the incidence of tumor recurrence after myomectomy in women with leiomyoma combined with endometriosis. 82 operated patients, included into rescarch were divided into two groups according to the criterion of the presence or absence of endometriosis of the uterus. Group I included 44 (53.7%) cases of isolated lyomyomyoma surgery, and group II - 38 (46.3%) cases of combination of a similar tumor with endometriosis of the uterus. Myomectomy was performed by the transabdominal way in 43.9%, laparoscopic – in 46.3%, transcervical with a hysteroresectoscope - 11.4% of cases of operative treatment. According to the 5 years observation after the surgery, the recurrence of uterine leiomyoma appeared in 56.1% of women of both groups, while in group II, where the combination of uterine leiomyoma with endometriosis was noted, the frequency of tumor recurrences was significantly higher (71.1%, p<0,05%) than in group I with isolated uterine leiomyoma (43.2%,). Thus, the long-term results of myomectomy in women with uterine leiomyoma are associated with the risk of recurrence of the tumor in almost every second woman, but with the combined pathology of the uterus, these cases have a number of features compared to an isolated tumor – 2.5 times higher risk of recurrence in the first year after the operation and by 1.65 times higher frequency of relapse of the leiomyoma within 5 years after the surgery. The authors suggest that these differences evidence that the presence of endometriosis of the uterus is an additional factor that initiates the mechanisms of recurrence of the uterine leiomyoma after miomectomy, which should be taken into account in the development of a program of postoperative reproductive health rehabilitation of women with co-pathology of the uterus. References AdamyanLV, Kulakov VI, Andreeva EN. [Endometrioses]. Moskva, OAO Izdatelstvo “Meditsina”. 2002;416. Russian. Grek LP [Features of systemic disorders in patients with genital endometriosis in combination with benign genital diseases and chronic pelvic pain syndrome]. Medicni perspektivi. Dnipro. 2017;22(4):62-67. Ukrainian. Guriev TD, Sidorova IS, Hunanyan AL. [The combination of uterine fibroids and adenomyosis]. Moskva, OOO MIA. 2012;256. Russian. Strizhakov AN, Davydov AI, Pashkov VM, Lebedev VA. [Benign diseases of the uterus]. Moskva, GEOTAR-Media; 2012. Russian. Kudinova NN, Frolov MV,NaumovNV, Shurshukov YY. [Medical and social characteristics of women with uterine myoma in combination with adenomyosis]. [Internet]. Available from: http://vrach-aspirant.ru/article/ gynecology/13525. Russian. Petrakova SA. [Features of pregnancy preparation of patients with uterine myoma. [dissertation]. Moskva, Akusherstvo i ginecologiya 2009;24. Russian. PotapovVA, Мedvedev МV, Ivakh VI. [Strategies of the therapy of endometriosis disease in combination with the uterine leiomyoma]. Zhurnal akusherstva i zhenskikh boleznei. 2012;LХI:26-27. Russian. Potapov VO, Мedvedev МV, Ivakh VI, Polshchikov PІ. [Predictors of recurrent leiomyoma of the uterus after myomectomy]. Zbirnik naukovikh pratch. Кyiv, Іntermed. 2008;193-5. Ukrainian. Cosson M, Querleu D, Donnez J, Madelenat P, et al. Dienogest is as eff ective as triptorelin in the treatment of endometriosis after laparoscopic surgery: results of a prospective, multicenter, randomized study. Fertil Steril 2002;77:684-92. Rickes D, Nickel I, Kropf S, Kleinstein J. Increased pregnancy rates after ultralong postoperative therapy with gonadotropin-releasing hormone analogs in patients with endometriosis. Fertil Steril 2002;78:757-62. Guo SW. Recurrence of endometriosis and its control. Hum Reprod Update 2009;15:441-61. Fagervold B, Jenssen M, Hummelshoj L, Moen M. Life after a diagnosis with endometriosis – a 15 years follow-up study. Acta Obstet Gynecol Scand 2009;88: 914-9. Harada T, Momoeda M, Taketani Y, Hoshiai H, et al. Low-dose oral contraceptive pill for dysmenorrhea associated with endometriosis: a placebo-controlled, double-blind, randomized trial. Fertil Steril 2008;90:1583-8. Shakiba K, Bena JF, McGill KM, Minger J, et al. Surgical treatment of endometriosis: a 7-year follow-up on the requirement for further surgery. Obstet Gynecol 2008;111:1285-92. 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