Network meta-analysis of Chinese herbal treatment and GnRH-a to prevent the post-operative recurrence of pelvic endometriosis

Objective To assess the clinical effects and safety of Chinese herbal treatment compared with GnRH-a for preventing the post-operative recurrence of pelvic endometriosis. Methods The relative randomized controlled trials (RCTs) of Chinese herbal treatment, GnRH-a and control groups were searched from PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure, Chinese Biomedical Literature Database and Wan-Fang Data, and the related references and website were also traced. The RCTs were screened according to the predefined inclusion and exclusion criteria. The related items were used to assess the quality of RCTs. Data were analyzed by STATA V.13.1 software. Results A total of 41 RCTs were included with 4 122 patients with pelvic endometriosis, while only 33 studies with 2 912 patients were analyzed of post-operative recurrence. Compared with the only surgery groups, GnRH-a and three kinds of Chinese herbal treatment (the medicine for activating blood circulation, the medicine for regulating the circulation of qi and blood, the medicine for strengthening kidney and promoting blood circulation) could significantly decrease the recurrence rate after operation, the OR(95% CI) were 0.35(0.24,0.50), 0.33(0.21,0.52), 0.18(0.09,0.36), 0.23(0.12,0.43), P<0.05. Conclusions GnRH-a and three kinds of Chinese herbal treatment (the medicine for activating blood circulation, the medicine for regulating the circulation of qi and blood, the medicine for strengthening kidney and promoting blood circulation) could significantly decrease the recurrence rate after operation. There was no significant difference among all interventions. Key words: Endometriosis; Postoperative period; Recurrence; Traditional Chinese medicine therapy; Gonadotropin releasing hormone angonist; Meta-analysis