Redwine, D. B. (1991). Conservative laparoscopic excision of endometriosis by sharp dissection: life table analysis of reoperation and persistent or recurrent disease. Fertility and sterility, 56(4), 628-34. https://doi.org/10.1016/s0015-0282(16)54591-9
Redwine DB. Conservative laparoscopic excision of endometriosis by sharp dissection: life table analysis of reoperation and persistent or recurrent disease. Fertility and sterility. 1991;56(4):628-34. doi:10.1016/s0015-0282(16)54591-9
Redwine, D. B. "Conservative laparoscopic excision of endometriosis by sharp dissection: life table analysis of reoperation and persistent or recurrent disease." Fertility and sterility, vol. 56, no. 4, 1991, pp. 628-34.
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Persistent or recurrent endometriosis after excision peaked at 19%
A surgeon followed 359 of his own patients after laparoscopic excision of endometriosis, with no adjunctive medical therapy. The estimated rate of persistent or recurrent disease peaked at 19% in year five. The peak equals about 2 out of 10 patients. When new disease appeared at reoperation, it was superficial.
Key Findings
The study tabulated 671.85 woman-years of follow-up in 359 patients. The longest follow-up was 9.82 years, and the mean was 2.03 years.
Persistent or recurrent disease reached a maximum cumulative rate of 19%, in the 5th postoperative year.
Of 91 reoperations reviewed, 81 were evaluable. Thirty-five patients had new endometriosis. For all 35, the new disease scored <6 on the revised AFS point total.
At reoperation, the endometriosis point score had decreased in 70 of 81 patients (86%) and was 0 in 46 (57%). No patient had deep disease at reoperation.
Interval rates of reoperation and of recurrence or persistence did not climb as years passed after surgery.
Interpretation
This is a single-surgeon case series with no comparison group, so it cannot show that excision caused these outcomes. Only patients whose visible disease could be completely excised by laparoscopy were included. Life tables adjust for people followed for different lengths of time. Mean follow-up was 2.03 years, and the count of patients still at risk shrinks each quarter in Table 3, so later-year estimates rest on fewer patients. The author says counting other surgeons' visual diagnoses as disease may overestimate the rate, while their less thorough exams may underestimate it.
RRM Context
Excision removes the disease itself, the surgical approach RRM endorses for endometriosis. The author noted that reoperated patients with continuing pain sometimes had little or no endometriosis. He suggested other causes of pain exist. A cause-based evaluation looks for those sources.
Our editorial summary of this paper, not the article's abstract.
Abstract
Objective
To determine the long-term outcome after laparoscopic excision of endometriosis.
Design
This longitudinal unmatched study evaluated surgical outcome using follow-up questionnaires and evaluation of reoperations with results presented in life table format.
Setting
Surgery was performed by a private practitioner at a referral center.
Patients
All 359 patients undergoing laparoscopic excision of endometriosis between December 12, 1980, and March 31, 1990, were studied.
Interventions
Endometriosis, including deeply invasive disease, was completely excised laparoscopically using 3-mm scissors and graspers. Adjunctive medical therapy was not used.
Main Outcome Measures
Extent of disease present at reoperation and quarterly rates of reoperation and recurrent/persistent disease are used as indicators of efficacy of surgery.
Results
Interval rates of reoperation and recurrence/persistence of disease and extent or invasiveness of disease when found at reoperation did not increase with the passage of time after surgery. The maximum cumulative rate of recurrent or persistent disease was 19%, achieved in the 5th postoperative year.
Conclusion
Laparoscopic excision of endometriosis results in a low rate of minimal persistent/recurrent disease. The natural history of endometriosis after surgery suggests a rather static nature of the disease.
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