SURGICAL INTERVENTIONS FOR ENDOMETRIOSIS: LONG-TERM OUTCOMES AND RECURRENCE RATES

Abstract

: Endometriosis affects up to 10 % of women of reproductive age; long-term data comparing contemporary surgical approaches remain limited.

Objective: To evaluate ten-year pain relief, recurrence, fertility, quality of life, and re-operation rates after laparoscopic conservative excision, laparoscopic ablation/fulguration, and definitive total hysterectomy with bilateral salpingo-oophorectomy (TH-BSO).

Methods: In a multicentre prospective cohort we followed 948 consecutively enrolled women for ≥10 years. Participants were assigned to excision (n = 318), ablation (n = 316), or TH-BSO (n = 314) according to planned surgery. Primary outcome was symptomatic recurrence (pelvic pain ≥ 40 mm on a 100-mm visual-analogue scale persisting ≥3 months). Secondary outcomes included imaging-confirmed relapse, spontaneous pregnancy within 24 months, EHP-30 quality-of-life scores, and re-operation-free survival. Kaplan–Meier methods and multivariable Cox models (robust variance for centre clustering) estimated time-to-event outcomes and independent predictors.

Results: Baseline characteristics were comparable between excision and ablation cohorts (mean age ≈ 32 y; stage III/IV disease ≈ 66 %). TH-BSO patients were older (38 ± 5 y) and more advanced (stage III/IV = 93 %). At 12 months median pain fell by 48 mm after excision, 38 mm after ablation, and 65 mm after TH-BSO. Ten-year symptomatic recurrence was 33.0 % for excision, 56.3 % for ablation, and 8.3 % for TH-BSO; corresponding imaging relapse rates were 28.9 %, 47.1 %, and 4.8 %. Spontaneous pregnancy occurred in 61.7 % of excision versus 43.6 % of ablation patients desiring fertility. Major 30-day complications were ≤3.5 % across groups. Independent predictors of recurrence were incomplete excision (adjusted HR 2.3), stage IV disease (HR 1.8), and smoking (HR 1.5), whereas continuous hormonal suppression was protective (HR 0.6).

Conclusions: Surgical radicality dictated long-term success. TH-BSO offered the most durable pain relief with minimal recurrence but eliminated fertility. Laparoscopic excision achieved superior durability and fertility outcomes compared with ablation, with acceptable morbidity. Ablation should be reserved for carefully selected low-burden cases or resource-limited settings; all patients benefit from postoperative hormonal suppression and lifestyle optimisation.