Identifying Preoperative Factors Associated with Nonresponders in Women Undergoing Comprehensive Surgical Treatment
Vishalli Ghai1, Haider Jan1, Fevzi Shakir2
1Department of Obstetrics and Gynaecology (Miss. Ghai and M Jan), Epsom & St. Helier's University Hospitals NHS Trust, Surrey, United Kingdom.
Study Objective:
To examine whether existing quality of health outcome measures can be used to predict or have an association with nonresponse surgery for endometriosis.
Design:
Retrospective cohort study.
Settings:
Single endometriosis referral center.
Patients:
Women (n = 198) undergoing surgery for endometriosis.
Interventions:
Validated health questionnaires and visual analogue scales.
Measurements And Main Results:
Patients were given validated health questionnaires, including Endometriosis Health Profile 30, Gastrointestinal Quality of Life Index, EuroQol-5, Hospital Anxiety and Depression Scale, preoperatively and at 12 months after full surgical excision of endometriosis. Visual analogue scales were also used that measured dyschezia, dysmenorrhea, dyspareunia, and chronic pelvic pain. Surgical management was dependent on severity of disease. Superficial disease was treated by laparoscopic peritoneal excision or laser ablation. Deep infiltrating disease involving the bowel was excised completely together with laparoscopic bowel surgery (shave, disc, or segmental resection) with/without concomitant total hysterectomy and bilateral salpingo-oophorectomy. Nonresponders were defined as women who failed to demonstrate an improvement in pain scores 12 months postoperatively. We examined preoperative and postoperative questionnaires, visual analogue scores, and other variables such as age at onset of symptoms, type of surgery, and the presence of postoperative complications comparing responder and nonresponder women to identify the factors associated with nonresponse. Of 102 women treated for superficial endometriosis, 25 (24.51%) were nonresponders. No factors were associated with nonresponse at 12 months. Of 96 women treated for severe endometriosis involving the bowel, 10 (10.41%) were nonresponders. Nonresponders had significantly less preoperative pain (p = .031) and feeling of control (p = .015) than responders. There was no association between nonresponders and women who underwent a hysterectomy with bilateral salpingo-oophorectomy or those with complications. Radical bowel surgery (resection) was associated with nonresponders.
Conclusion:
Minimal preoperative factors are associated with nonresponse for women having surgery for endometriosis. The severity of pain experienced by women with endometriosis may be used to predict their response to surgery.
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