Fatores preditores de recorrência do endometrioma ovariano após tratamento laparoscópico

Abstract

ResumoOBJETIVO: Analisar os fatores que possam influenciar na recorrência do endometrioma ovariano após tratamento videolaparoscópico. MÉTODOS: Estudo de coorte retrospectivo. Foram avaliadas 129 pacientes submetidas à videolaparoscopia, entre 2003 e 2012, para tratamento de endometrioma ovariano, com seguimento pós-operatório mínimo de 2 anos. Foi realizada ultrassonografia transvaginal para excluir persistência da lesão e identificação de recidiva. Para comparação de variáveis contínuas foi utilizado o teste t de Student, e para o teste de homogeneidade entre as proporções, o teste do χ 2 ou exato de Fisher (para frequências menores do que cinco). Para a obtenção de fatores prognósticos ligados à recidiva foi aplicado o modelo de regressão linear multivariado. O nível de significância utilizado para a análise foi de 5%. RESULTADOS: A taxa de recorrência foi de 18.6%. O tamanho do endometrioma, a modalidade cirúrgica empregada e os dados demográficos como idade, índice de massa corpórea, presença de sintomas, tabagismo e prática de exercícios físicos não se associaram ao aumento da recorrência. Foi observado que a interrupção do tratamento clínico pós-operatório apresentou risco significativo para aumento da recorrência (OR 23,7; IC95% 5,05; p=0,001). CONCLUSÃO: O uso contínuo de contracepção oral parece reduzir dramaticamente a taxa de recidiva de endometrioma ovariano. Neste estudo, a interrupção do tratamento foi o fator associado com maior taxa de recidiva da lesão após o tratamento videolaparoscópico. Abstract PURPOSE:To analyze the factors that might influence the recurrence of ovarian endometriomas after laparoscopic excision. METHODS: A retrospective cohort study. We evaluated 129 patients who underwent laparoscopic excision of ovarian endometriomas from 2003 to 2012 and who were followed up for at least two years after surgery. Vaginal ultrasound was repeated to exclude persistent lesion and to identify recurrence. The Student's t-test was used to compare continuous variables and the χ 2 or Fischer exact test (for values of less than five) was used to test homogeneity between proportions. A logistic regression model for multivariate proportional hazards was used to analyze predictors of long-term outcome. The level of significance was set at 5% in all analyses. RESULTS: The overall rate of ovarian endometrioma recurrence was 18.6%. Endometrioma diameter, surgical procedure techniques and demographic data such as age, presenting symptoms, body mass index, smoking and physical exercise habits were not associated with recurrence, whereas interruption of postoperative medical treatment was significantly correlated with a higher recurrence rate (OR 23.7; p=0.001). CONCLUSION: Current oral contraceptive use appears to be associated with a dramatic reduction in the risk of recurrence of ovarian endometriotic cysts. Treatment interruption was associated with a higher recurrence rate of ovarian endometrioma after laparoscopic treatment.

Ginsenoside Rg3 inhibits angiogenesis in a rat model of endometriosis through the VEGFR-2-mediated PI3K/Akt/mTOR signaling pathway

“…Surgery can remove ectopic foci, recover normal pelvic anatomy, relieve pain, and increase the chances of pregnancy. Drug therapy aims to inhibit the ovarian hormone secretion, but the effect is short-lived and has side effects such as the onset of menopausal symptoms and osteoporosis [ 5 ]. Regardless of treatment, EMs has a high recurrence rate.…”

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“…The opposite effect is found in patients that discontinue treatment, even for a transient period of time. Therefore, it is clear that maintenance of postoperative clinical treatment is essential for preventing recurrence of endometriomas, which is found in other studies [10,13,26,27]. It is indispensable to inform patients about it, as well as the need for their adherence in the success of treatment.…”

“…Ultrasonography may seem more objective and feasible for comparison. Some authors establish as recurrence ovarian endometriomas equal or larger than 20mm detected on transvaginal ultrasonography [13,17]. Yet, there is no definition of persistence, as well as its distinction from recurrence.…”

“…However, simple coagulation or vaporization would result in the persistence of ectopic endometrium and an increase in the risk of short-term cyst recurrence [4,9]. Therefore, as compared with drainage and ablation, excisional surgery provides more favorable outcomes with regard to recurrence of endometrioma, recurrence of symptoms, and subsequent spontaneous pregnancy in infertile women, although it may decrease ovarian reserve [9,12,13].…”

“…Recurrence risk increases if the lesions are not completely removed at surgical approach, and they tend to arise on the same location [14]. Also, even the most pristine surgical technique cannot guarantee removal of all microscopic lesions and therefore hormonal therapy is highly recommended after surgery [13,14]. The aim of postoperative medical treatment is suppressing ovarian activity and, in turn, leading to atrophy of the lesions [14].…”