Recurrence of endometrioma after laparoscopic excision and its prevention by medical management

Kaori Koga, Yutaka Osuga, Yuri Takemura, Masashi Takamura, Yuji Taketani
Frontiers in bioscience (Elite edition) · 2012 · vol. E5(2) , pp. 676–683 · doi:10.2741/e648 · PMID:23277022 · W2334670183
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Laparoscopic excision of ovarian endometrioma carries a 11-32% recurrence rate, which can be reduced by immediate conception attempts or hormonal therapy for women not seeking pregnancy.

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Abstract

Laparoscopic excision is considered as the 'gold standard' treatment of ovarian endometrioma. However, a frustrating aspect is that disease can recur. While laparoscopic excision is known to improve fertility, recurrence can cause significant ovarian damage and adverse affects on fertility. It is therefore crucial to prevent recurrence in order to conserve 'improved' fertility. Recurrence rates for endometrioma are reported from 11 to 32% within 1-5 years after excision. The recurrence rate is higher in patients with advanced endometriosis at surgery and in younger patients. Previous medical treatment for endometriosis prior laparoscopy is a risk factor for recurrence. Pregnancy soon after surgery has a protective effect for recurrence. The accumulating evidence suggests that the administration of oral contraceptives (OC), levonorgestrel-releasing intrauterine system (LNG-IUS) and a combination of gonadotropin releasing hormone (GnRH) analogue and OC may also have therapeutic benefits. Collectively, we propose that women should be well informed about the risks of endometrioma recurrence. We recommend that women who wish pregnancy should try conception as soon as possible. Further, we strongly advise hormonal therapy for patients, who do not want to conceive immediately, and until pregnancy is desired.
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Abstract

Laparoscopic excision is considered as the ‘gold standard’ treatment of ovarian endometrioma. However, a frustrating aspect is that disease can recur. While laparoscopic excision is known to improve fertility, recurrence can cause significant ovarian damage and adverse affects on fertility. It is therefore crucial to prevent recurrence in order to conserve ‘improved’ fertility. Recurrence rates for endometrioma are reported from 11 to 32% within 1-5 years after excision. The recurrence rate is higher in patients with advanced endometriosis at surgery and in younger patients. Previous medical treatment for endometriosis prior laparoscopy is a risk factor for recurrence. Pregnancy soon after surgery has a protective effect for recurrence. The accumulating evidence suggests that the administration of oral contraceptives (OC), levonorgestrel-releasing intrauterine system (LNG-IUS) and a combination of gonadotropin releasing hormone (GnRH) analogue and OC may also have therapeutic benefits. Collectively, we propose that women should be well informed about the risks of endometrioma recurrence. We recommend that women who wish pregnancy should try conception as soon as possible. Further, we strongly advise hormonal therapy for patients, who do not want to conceive immediately, and until pregnancy is desired.

Keywords

- Endometriosis - Laparoscopy - Recurrence - Oral Contraceptives - Review

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Condition tags

mesh:D004715endometriosisendometrioma

MeSH descriptors

Endometriosis Endometriosis Laparoscopy Neoplasm Recurrence, Local Neoplasm Recurrence, Local Contraceptives, Oral Contraceptives, Oral Endometriosis Female Humans Japan Japan Levonorgestrel Logistic Models Neoplasm Recurrence, Local Neoplasm Recurrence, Local Risk Factors

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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. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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Cited by (29)

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