Adenomyosis has relatively high long-term recurrence rate after conservative surgery, finds study

Adenomyosis, a prevalent non-cancerous condition, is characterized by the erroneous presence of endometrial tissue within the myometrium. Symptoms include dysmenorrhea, abnormal uterine bleeding, and dyspareunia, adversely affecting patients' quality of life. Diagnostic methods rely heavily on clinical judgment and imaging techniques like ultrasonography or magnetic resonance imaging due to the absence of definitive physical or laboratory indicators for adenomyosis. Recent retrospective study aimed to determine the recurrence rate after conservative surgery for adenomyosis and identify the risk factors for recurrence. Data from 133 eligible patients who underwent conservative surgery for adenomyosis between January 2013 and April 2023 were analyzed. The recurrence rate after conservative surgery was 39.1% (52/133) during a mean follow-up of 52 months. 2. Cox proportional hazards analysis identified several risk factors for recurrence: - Adenomyosis involving the posterior uterine wall (hazard ratio \[HR\] 6.505, p=0.018) - Two or more adenomyotic lesions (HR 6.310, p=0.030) - Laparotomy approach (HR 2.490, p=0.029) - Concomitant endometriosis (HR 2.313, p=0.036) - Higher number of abortions (HR 1.578, p=0.001) - Higher preoperative visual analog scale (VAS) pain score (HR 1.181, p=0.036) 3. In contrast, postoperative combined progestogen therapy (HR 0.126, p<0.001) or gonadotropin-releasing hormone agonist (GnRHa) therapy (HR 0.237, p=0.004) were found to protect against recurrence of adenomyosis.

Conclusion

The authors conclude that adenomyosis has a relatively high long-term recurrence rate after conservative surgery. Patients with adenomyosis involving the posterior uterine wall, multiple lesions, and concomitant endometriosis are at high risk of recurrence. Postoperative hormonal therapy with progestogens or GnRHa may reduce the risk of recurrence. Larger prospective studies are needed to confirm these findings.

Key Points

1. The recurrence rate after conservative surgery for adenomyosis was 39.1% during a mean follow-up of 52 months.

2. Several risk factors for recurrence were identified, including: - Adenomyosis involving the posterior uterine wall (hazard ratio \[HR\] 6.505) - Two or more adenomyotic lesions (HR 6.310) - Laparotomy approach (HR 2.490) - Concomitant endometriosis (HR 2.313) - Higher number of abortions (HR 1.578) - Higher preoperative visual analog scale (VAS) pain score (HR 1.181)

3. Postoperative combined progestogen therapy (HR 0.126) or gonadotropin-releasing hormone agonist (GnRHa) therapy (HR 0.237) were found to protect against recurrence of adenomyosis.

4. The authors conclude that adenomyosis has a relatively high long-term recurrence rate after conservative surgery.

5. Patients with adenomyosis involving the posterior uterine wall, multiple lesions, and concomitant endometriosis are at high risk of recurrence.

6. Larger prospective studies are needed to confirm these findings.

Reference –

Lu, K., Zhong, G., Lian, B. et al. Recurrence rates and associated risk factors after conservative surgery for adenomyosis: a retrospective study. BMC Women's Health 24, 619 (2024). https://doi.org/10.1186/s12905-024-03457-6