深部子宮内膜症手術を受ける青年および若年成人患者の特徴：多施設データベース研究

To determine the characteristics of adolescent and young adult patients undergoing surgery for severe endometriosis.

We analysed the British Society for Gynaecological Endoscopy (BSGE) database, a multicenter database of research-consented patients undergoing excision of surgically-confirmed deep endometriosis, from 2009 to 2021, which includes prospectively-collected preoperative questionnaire data and intraoperative findings reported by the surgical team at laparoscopy. Patients were divided into adolescent (10-19yrs), young adult (20-24yrs) and older adult (≥25yrs) groups. Preoperative questionnaires and intraoperative findings were compared between groups RESULTS: 14670 patients were included from 104 specialist endometriosis centers, of which 186 were adolescents and 892 were young adults. Young adults had worse premenstrual and menstrual pain, dyspareunia, dysuria and bladder voiding difficulty than older adults, despite higher use of hormonal contraceptives (35.1% vs 17.7%, p<.001) and opioids (32.5% vs 27.8%, p=0.004). Adolescent patients had lower prevalence of bowel (66.7% vs 81.1%, p<.001), ovarian (30.6% vs 51%, p<.001), deep sidewall (65.1% vs 78.1%, p<.001) and uterosacral ligament endometriosis (74.2% vs 85.0%, p<.001) compared to older adults. The same was true for young adults, who also had higher rates of superficial disease (79.7% vs 70.9%, p<.001) than older adults. Older adults had a higher number of pelvic sites affected by endometriosis than adolescents (6.0 vs 4.57, p<.001) and young adults (6.0 vs 4.9, p<.001).

Adolescent and young adult patients undergoing endometriosis surgery report severe pre-operative symptoms, but have fewer anatomical sites affected and fewer deep endometriotic lesions. These findings highlight differences in lesion distribution that warrant further investigation into disease progression.