Analysis of recurrence factors associated with conservative surgery for ovarian-type endometriosis

To investigate the factors associated with postoperative recurrence in patients with ovarian-type endometriosis (EMS) who were treated with conservative surgery and to provide ideas for preventing disease recurrence in advance of treatment.

The study included data from 289 inpatients with ovarian-type EMS who underwent conservative laparoscopic surgery in the Department of Gynecology, Changzhou Maternal and Child Health Care Hospital, Nanjing Medical University, from 2018 to 2020. We collected general clinical data, postoperative recurrence, drug treatment, and follow-up information. The factors associated with recurrence were analyzed using SPSS 26.0 software.

A total of 289 patients were included in this study, including 49 patients with recurrence and 240 without recurrence. In the univariate analysis of recurrence, revised American Fertility Society (r-AFS) score, preoperative dysmenorrhea, EMS fertility index (EFI) score, combined myoma, and postoperative pregnancy affected postoperative recurrence of patients. The critical value of r-AFS was 70 according to the subject receiver operating characteristic curve (ROC), and the Youden index was 0.513. R-AFS >70 had a sensitivity of 57.1%, specificity of 94.2%, the positive predictive value of 66.7%, the negative predictive value of 91.5%, and diagnostic accuracy of 87.9% for the diagnosis of recurrent ovarian endometrioid cysts. Using multifactorial binary logistic regression, results showed that r-AFS score >70 [odd ratio (OR) =1.042; 95% confidence interval (CI): 1.028-1.055; P<0.05], myoma (OR =2.995; 95% CI: 1.429-6.275; P<0.05), and preoperative dysmenorrhea (OR =1.994; 95% CI: 1.071-3.713; P<0.05) were risk factors for recurrence. EFI score (OR =0.785; 95% CI: 0.661-0.931; P<0.05), postoperative pregnancy (OR =0.349; 95% CI: 0.132-0.920; P<0.05) were protective factors for recurrence. The differences were statistically significant, and the remaining differences were not statistically significant.

Preoperative r-AFS level, preoperative dysmenorrhea, and combined myoma are risk factors for postoperative recurrence, so patients with an r-AFS score over 70 should be more alert to possible recurrence. Moreover, EFI score and postoperative pregnancy are protective factors for postoperative recurrence. Postoperative patients should routinely take medication for prevention, and patients with the intention to become pregnant should be encouraged to conceive as soon as possible to reduce recurrence.