Selçuk, I., & Bozdağ, G. (2013). Recurrence of endometriosis; risk factors, mechanisms and biomarkers; review of the literature. Journal of the Turkish German Gynecological Association. https://doi.org/10.5152/jtgga.2013.52385
Selçuk I, Bozdağ G. Recurrence of endometriosis; risk factors, mechanisms and biomarkers; review of the literature. Journal of the Turkish German Gynecological Association. 2013. doi:10.5152/jtgga.2013.52385
Selçuk, Ilker, and Gürkan Bozdağ. "Recurrence of endometriosis; risk factors, mechanisms and biomarkers; review of the literature." Journal of the Turkish German Gynecological Association, 2013.
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RRM Academy Synopsis
What Makes Endometriosis More Likely to Come Back After Surgery
This review looked at years of surgery studies on why endometriosis comes back. Some studies followed a few dozen women. Others followed over 1,100 women. Recurrence rates ranged from 6% to 67% across the studies. Each study measured recurrence a different way.
Key Findings
Across the studies reviewed, reported recurrence rates ranged from 6% to 67%, depending on whether recurrence was defined by patient-described pain, exam or imaging findings, or persistent infertility.
Busacca et al. followed 1,106 women. Four-year recurrence ranged from 17.8% to 30.6% and eight-year recurrence from 24.1% to 43.4%, across four disease types.
Among 710 women followed for an average of 22.4 months (Liu et al.), recurrence risk stayed steady for about 30 months after surgery. After that, the risk rose sharply.
A Cochrane review cited in the paper found that excisional surgery for ovarian endometriomas led to fewer recurrences than drainage or ablation.
In 109 women (Shen et al.), two tissue markers together, NF-kB p65 and PR-B, identified recurrence of ovarian endometrioma. Sensitivity and specificity were both at least 80%.
Interpretation
This is a review of past research. The paper is not a new study. The authors pull together many surgery studies. Included studies differed in size, follow-up time, and how they defined recurrence, making the reported rates hard to compare directly. Most of the research just watched women after surgery, without randomly assigning treatments. So it can show a pattern, like younger age or advanced disease linking to more recurrence, without proving what causes what. The biomarker findings come from small lab studies. They are an early research signal. Routine care does not yet use this test. The review was published in 2013, reflecting evidence available up to then.
RRM Context
One finding fits the restorative surgical standard RRM supports. For ovarian endometriomas, excisional surgery led to fewer recurrences than drainage or ablation. The review also describes studies of medication after surgery, and the results are mixed. Danazol for 3 months made no difference to recurrence in one trial. Oral contraceptives lowered recurrence at one year in another, but not at 24 or 36 months. A separate study of medical treatment taken before surgery linked it to higher recurrence. Suppression works only while it lasts. Tracking symptoms through cycle charting after surgery may help spot a returning pattern early, alongside routine follow-up exams.
Our editorial summary of this paper, not the article's abstract.
Abstract
Endometriosis has a wide clinical spectrum and induces a chronic inflammatory process. The incidence of endometriosis in women with dysmenorrhoea is up to 40-60%, whereas in women with subfertility is up to 20-30%. Recurrence of endometriosis varies greatly among different studies. The overall recurrence rates range between 6 to 67% according to the criteria that are taken into consideration. Which of the various reasons is more predictive for recurrence is still unclear and controversial. The main aim of post-operative medical treatment is suppressing ovarian activity leading to atrophy of endometriotic lesions. The success of treatment depends on the resorption of all residual visible lesions and the eradication of microscopic implants. The recurrent lesions might originate from residual lesions or from de novo cells. Determining risk factors for recurrence may allow the identification of subgroups at risk for disease control. Potential biomarkers for recurrence could also maintain targeted therapy.
