Reproductive performance, pain recurrence and disease relapse after conservative surgical treatment for endometriosis: the predictive value of the current classification system

Paolo Vercellini, Luigi Fedele, Aimi G, Giorgio Aimi, Olga De Giorgi, Consonni D, Dario Consonni, Pier Giorgio Crosignani, Crosignani PG, P.G. Crosignani
Human Reproduction · 2006 · vol. 21(10) , pp. 2679–2685 · doi:10.1093/humrep/del230 · PMID:16790608 · W2136277417
Observational OA: bronze CC0 ⤵ 201 in-corpus citations
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This study found that the current endometriosis classification system inadequately predicts post-operative pregnancy rates, pain recurrence, and disease relapse after conservative laparoscopic surgery.

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Abstract

BACKGROUND: To assess the predictive value of the current classification of endometriosis in terms of response to surgical treatment, we studied to what extent disease stage, lesion type and lesion site were associated with post-operative pregnancy rate, symptom recurrence and disease relapse. METHODS: A total of 729 women with endometriosis undergoing first-line conservative laparoscopic surgery were included. Data on age at surgery, disease stage according to the revised American Fertility Society (AFS) classification, anatomical characteristics of endometriotic lesions, fertility status and types and severity of pain symptoms were collected. RESULTS: Minimal endometriosis was present in 222 patients, mild in 106, moderate in 197 and severe in 204. The cumulative probability of pregnancy at 3 years from surgery in 537 infertile women was 47% (51% at stage I, 45% at stage II, 46% at stage III and 44% at stage IV; log-rank test, chi(2)3=1.50, P=0.68). The cumulative probability of moderate or severe dysmenorrhoea recurrence in 425 symptomatic subjects was 24% (32% at stage I, 24% at stage II, 21% at stage III and 19% at stage IV; log-rank test, chi2(3)=6.39, P=0.094). The cumulative probability of disease relapse was 12% (3% at stage I, 11% at stage II, 11% at stage III and 23% at stage IV; log-rank test, chi(2)3=24.95, P=0.0001). Using Cox's multivariate proportional hazards regression analysis, no association was observed between endometriosis stage or lesion type and lesion site and any of the considered study outcomes. CONCLUSIONS: The current classification of endometriosis has an inadequate predictive value with regard to the major clinical outcomes.

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Condition tags

dysmenorrheaendometriosis

MeSH descriptors

Endometriosis Endometriosis Laparoscopy Laparoscopy Pregnancy Outcome Pregnancy Outcome Reproduction Adult Adult Body Mass Index Body Mass Index Disease Progression Disease Progression Dysmenorrhea Dysmenorrhea Endometriosis Endometriosis Endometriosis Endometriosis Female

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Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. Outer rings show 2-hop neighbours — papers reached through the immediate citers/citees. [ collapse to 1-hop ]

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