Recurrence-associated factors of laparoscopic adenomyomectomy for severely symptomatic adenomyoma

The present study aimed to identify which patients with adenomyoma would benefit from sparing the uterus and which patients should undergo a hysterectomy to avoid secondary surgery. Patients with pathology-proven adenomyoma admitted to Beijing Chao-Yang Hospital between November 2005 and November 2015 were retrospectively reviewed. Relief and reappearance of dysmenorrhea following laparoscopic adenomyomectomy were evaluated. All 49 patients (mean age, 40.6±5.2 years; age range, 26-51 years) presented with severe dysmenorrhea prior to surgery. Dysmenorrhea was identified to be relieved in 83.7% (41/49) of patients at the 6-month follow-up. No factors were revealed to have a significant effect on the surgical outcome. The median follow-up period was 4.6 (1-11) years; and 24.5% (12/49) of patients experienced recurrence of dysmenorrhea. Multivariate analysis identified preoperative serum cancer antigen 125 (CA 125) levels [hazard ratio (HR), 2.356; 95% confidence interval (CI), 1.271-3.570; P=0.011], postoperative gonadotropin-releasing hormone agonist (GnRH-a) treatment (HR, 0.540; 95% CI, 0.241-0.873; P=0.017) and accompanying endometriosis (HR, 2.182; 95% CI, 1.556-3.031; P=0.003) as independent risk factors for relapse. Laparoscopic adenomyomectomy is effective for alleviating dysmenorrhea in patients with adenomyoma. Patients with lower preoperative serum CA 125 levels without accompanying endometriosis benefited greater from adenomyomectomy compared with all other patients. Postoperative GnRH-a treatment strengthens therapeutic effects.