Thoracic Endometriosis Syndrome: A Systematic Review and Meta-Analysis of Surgical Outcomes Among 1,182 Patients Over 25 Years

OBJECTIVE: Without standardized guidelines, the management of thoracic endometriosis syndrome (TES) continues to fuel debate. Previous reviews have reported poor outcomes but lack data on complications, hospital length of stay (LOS) and chest tube drainage. Our study includes the largest number of TES patients till date and aims to evaluate postoperative outcomes. DATA SOURCES: PubMed, Scopus, and EMBASE were searched up to March 2024 using Medical Subject Headings and free text combinations. METHODS OF STUDY SELECTION: We included all studies on adults with diagnosed or suspected TES who received surgical treatment. Study quality was evaluated using the Newcastle-Ottawa scale. TABULATIONS, INTEGRATION AND RESULTS: Twenty-eight studies including 1182 patients met our eligibility criteria. Meta-analysis was performed using Open Meta-analyst to calculate the effect measures within a random effects model. Pneumothorax recurrence was 28.2% (95% CI: 0.218-0.345, I2 = 80.07%) and reoperation rate was 14.0% (95% CI: 0.062-0.218, I2 = 72.97%). The overall complication rate was 30.8% (95% CI: 0.144-0.473, I2 = 92.41%) and prolonged air leak rate was 24.2% (95% CI: 0.101-0.383, I2 = 91.5%). On average, chest drains remained in situ for 4.4 days (95% CI: 2.924-5.899, I2 = 97.95%) and LOS was 6.1 days (95% CI: 3.774-8.367, I2 = 97.18%). CONCLUSIONS: Our findings reveal a clinically meaningful burden of postsurgical pneumothorax recurrence, reoperation and complications among TES patients. Additionally, prolonged hospitalization and chest tube drainage underscore important clinical considerations. Further high-quality research on patient-reported outcomes and quality-of-life(QoL) data are needed to establish standardized protocols.