"Better treatment" seen needed for endometriosis

By Megan Rauscher

NEW YORK (Reuters Health) - Key-hole surgery to treat endometriosis is associated with good short-term outcomes but has a high reoperation rate in the long run, research suggests. Hysterectomy, on the other hand, while "too radical," is associated with a low reoperation rate, the study team found, and preservation of the ovaries is a "viable option."

Endometriosis is a painful condition that affects women during their reproductive years and is caused by the growth of the tissue lining the uterus in other parts of the abdomen outside of the uterus, such as the ovaries.

For their research, Dr. Tommaso Falcone and colleagues from the Cleveland Clinic, Ohio, investigated the need for further surgery after laparoscopic excision of endometriosis or hysterectomy (removal of the uterus) in a "look-back" study involving 240 women.

Women treated with hysterectomy had significantly fewer postsurgical reoperations than women treated with "conservative" surgery, the team reports in the journal Obstetrics & Gynecology.

The failure rate was more than twofold higher with conservative local surgery in comparison with hysterectomy without removal of the ovaries. The failure rate was more than sixfold higher with conservative local surgery in comparison with hysterectomy with removal of the ovaries.

In comments to Reuters Health, Falcone said, "Endometriosis is a chronic disease with a high recurrence after laparoscopic surgery. We need better treatment."

Among women who had local excision with ovarian preservation (at least one ovary was preserved), 79 percent were "reoperation-free" at 2 years. At 5 and 7 years, 53 percent and 45 percent, respectively, were reoperation-free.

Among women who had hysterectomy without ovary removal, the 2-, 5- and 7-year reoperation-free percentages were higher (96 percent, 87 percent, and 77 percent, respectively). Among women who underwent hysterectomy with removal of the ovaries, the reoperation-free percentages were 96 percent, 92 percent and 92 percent, respectively.

"Hysterectomy has a low recurrence rate but is obviously too radical, especially for women that want to get pregnant," Falcone noted.

"Contrary to dogma, removing the ovaries in women at the time of hysterectomy does not have a major impact on success and therefore consideration should be given to keeping them," the researcher added.

SOURCE: Obstetrics and Gynecology, June 2008.