Up to 27 Percent Endometrioma Recurrence Rate Detected in absence of Post-Surgical Hormonal Therapy: Study

The meta-analysis revealed that endometrioma recurrence rates after surgery can reach up to 27% by 24 months, especially among women who do not use postoperative hormonal therapy. The study documented recurrence rates of 4% at three months, 14% at six months, 17% at 12 months, and 27% at 24 months, highlighting the persistent challenge of managing endometriomas without hormonal treatment.

Endometriomas are ovarian cysts filled with old blood that result from endometriosis, a condition where tissue similar to the lining of the uterus grows outside it. These endometriomas can, in addition to medical treatment, be treated surgically. After surgery, hormonal therapy is still frequently used for the treatment of endometriosis in general and the prevention of the recurrence of endometriomas specifically. However, not all women want or can receive postoperative hormonal treatment. This group needs to know the risk of anatomical recurrence of ovarian endometrioma after surgery for an endometrioma.

Against the above background, Veerle B. Veth, Maastricht University Medical Center (MUMC+), Department of Obstetrics & Gynecology, Maastricht, the Netherlands, and colleagues aimed to determine the recurrence rate for surgically treated endometrioma, without postoperative hormonal treatment.

For this purpose, the researchers performed a systematic literature review and meta-analyses, according to the PRISMA guidelines. MEDLINE, EMBASE, and the Cochrane Library were searched up to May 2023, focusing specifically on studies involving women with endometriomas who underwent surgical treatment without subsequent hormonal therapy.

5367 articles were screened, of which ninety-seven articles were systematically reviewed and fifty-five included in the systematic review.

The researchers reported the following findings:

• Twelve were randomized controlled trials, eleven prospective cohort studies, and thirty-two retrospective studies.
• Nine randomized controlled trials (RCTs) were assigned as low risk of bias. For non-RCTs, only three studies had a low risk of bias.
• Data from twenty-three studies were pooled in meta-analyses performed for follow-up periods of 3, 6, 12, and 24 months.
• These studies showed a recurrence rate of 4%, 14%, 17% and 27% respectively.

The meta-analysis revealed that, at 24 months following surgery, the weighted average recurrence rate for endometriomas reached up to 27%.

"The study aimed to determine the recurrence rate of endometriomas in the absence of postoperative hormonal treatment. The findings indicated that recurrence rates can be as high as 27% in this patient population," the researchers concluded.

Reference:

Veth VB, Keukens A, Reijs A, Bongers MY, Mijatovic V, Coppus SFPJ, Maas JWM. Recurrence after surgery for endometrioma: a systematic review and meta-analyses. Fertil Steril. 2024 Aug 2:S0015-0282(24)00629-0. doi: 10.1016/j.fertnstert.2024.07.033. Epub ahead of print. PMID: 39098538.