Long-term surgical outcomes of nerve-sparing discoid and segmental resection for deep endometriosis

Purpose Endometriosis predominantly affects women in their reproductive age and may impair quality of life (Qol) and fertility. Deep lesions are usually related with more adverse pain and gastrointestinal (GI) outcomes (1) (2, 3),(4). The optimal treatment modality for symptomatic DE should improve QoL and preserve or improve fertility with low recurrence and complication rates. Within this, several studies have demonstrated a significant decrease in pain symptoms in women following sugical treatment for colorectal DE (5, 6),(7),(8). However, there is an ongoing debate in how far surgical radicality reflected by eitther segmental colorectal resection, discoid resection or so-called rectal shaving is really warranted in order to achieve optimal surgical outcomes including preservation of gastrointestinal function (9). The aim of this study was to investigate the long-term outcomes in terms of pain, QoL and gastrointestional (GI) symptoms in women following colorectal surgery for deep endometriosis (DE).

Methods Women who underwent surgical treatment for DE by either nerve sparing full thickness discoid resection (DR) or colorectal segmental resection (10) between March 2011 to August 2016 were re-evaluated regarding pain symptoms, QoL and GI outcomes.

Results The median follow-up time was 86 months at final visit 2. Out of 134 patients, 77 were were eligible for final analysis and 57 were lost to follow-up. Compared to presurgical values, significantly decreased OoL scores were observed at the postoperative visit 1 and 2 in both, SR (3 (2-4) vs. 8.5 (8-9) and 10 (8-10) p < 0.001, SR group) and DR cohorts (3 (2-4) vs. 9 (8-10) and 10 (0-10), p < 0.001). Pain scores for dysmenorrhea (8 (7-9) vs. 2 (0-4) and 2 (0-4), p < 0.001, SR group and 9 (8-10) vs 2 (0-3) and 1 (0-2), p < 0.001 in DR patients), dyspareunia (4 (0-6) vs. 0 (0-1) and 0 (0-2), p < 0.001, SR; 5 (0-7) vs. 0 (0-4) and 1 (0-2), p=0.003, DR) and dyschezia (8 (7-9) vs. 2 (0-4) and 2 (0-4), p < 0.001, SR and 9 (8-10) vs. 2 (0-3) and 1 (0-2), p < 0.001, DR), significantly decreased after surgery and remained stable in both cohorts over the follow-up period. Gastrointestinal function reflected by minor and major lower anterior resection syndrome LARS) was observed at visit 1 and 2 in 6.5% and 8.1% and 3.2% and 3.2% of SR patients and 13.3% and 6.7% and 0% and 0% of DR patients without significant differences between SR and DR.

Conclusion Colorectal surgery for DE either by discoid or segmental resection provides stable and long-term pain relief with low rates of permanent GI function impairment [1] [2] [3] [4] [5] [6] [7] [8] [9] [10].

 

MissingLinkText

Conflict of interest

The authors have no conflicts of interest to declare.

• References

• 1 Fourquet J, Gao X, Zavala D, Orengo JC, Abac S, Ruiz A. et al. Patients' report on how endometriosis affects health, work, and daily life. Fertil Steril 2010; 93 (07) 2424-8
• 2 Turco LC, Scaldaferri F, Chiantera V, Cianci S, Ercoli A, Fagotti A. et al. Long-term evaluation of quality of life and gastrointestinal well-being after segmental colo-rectal resection for deep infiltrating endometriosis (ENDO-RESECT QoL). Arch Gynecol Obstet 2020; 301 (01) 217-28
• 3 Montanari E, Dauser B, Keckstein J, Kirchner E, Nemeth Z, Hudelist G. Association between disease extent and pain symptoms in patients with deep infiltrating endometriosis Reproductive biomedicine online. 2019.
• 4 Schliep KC, Mumford SL, Peterson CM, Chen Z, Johnstone EB, Sharp HT. et al. Pain typology and incident endometriosis. Hum Reprod 2015; 30 (10) 2427-38
• 5 Iversen ML, Seyer-Hansen M, Forman AJ, Aoeg S. Does surgery for deep infiltrating bowel endometriosis improve fertility?. A systematic review 2017; 96 (06) 688-93
• 6 De Cicco C, Corona R, Schonman R, Mailova K, Ussia A, Koninckx P. Bowel resection for deep endometriosis: a systematic review. Bjog 2011; 118 (03) 285-91
• 7 Byrne D, Curnow T, Smith P, Cutner A, Saridogan E, Clark TJ. Laparoscopic excision of deep rectovaginal endometriosis in BSGE endometriosis centres: a multicentre prospective cohort study. BMJ Open 2018; 8 (04) e018924
• 8 Riiskjaer M, Forman A, Kesmodel US, Andersen LM, Ljungmann K, Seyer-Hansen M. Pelvic Pain and Quality of Life Before and After Laparoscopic Bowel Resection for Rectosigmoid Endometriosis: A Prospective, Observational Study. Dis Colon Rectum 2018; 61 (02) 221-9
• 9 Donnez O, Roman H. Choosing the right surgical technique for deep endometriosis: shaving, disc excision, or bowel resection?. Fertility and Sterility 2017; 108 (06) 931-42
• 10 Friedenreich C, Cust A, Lahmann PH, Steindorf K, Boutron-Ruault MC, Clavel-Chapelon F. et al. Anthropometric factors and risk of endometrial cancer: the European prospective investigation into cancer and nutrition. Cancer Causes Control 2007; 18 (04) 399-413

Publication History

Article published online:
10 June 2022