title: Comparison of complete and incomplete excision of deep infiltrating endometriosis.
abstract: OBJECTIVE
  To compare the efficacy and safety of complete and incomplete excision of deep infiltrating endometriosis (DIE).
  
  
  METHODS
  Ninety-three women who underwent complete excision (n=55) or incomplete surgery of DIE (n=38) between January 2011 and December 2013 were included in this retrospective cohort study. Surgical data, and follow-up information of the patients were analyzed.
  
  
  RESULTS
  Eighty-five women (91.4%) returned for their follow-up after the operation. The mean follow-up time was 18.3±8.7 months. The complete excision group had a significantly higher complication rate than the incomplete excision group (9.1% VS 0%, P<0.001). The decrease of visual analog scale (VAS) scores were more significant (5.6±3.9 VS 2.9±3.3, P=0.001), and the postoperative recurrence rate is significantly lower (3.9% VS 35.3%, P=0.000) in the complete excision group than that in the in-complete surgery group. The palliative incomplete excision had a comparable pregnancy rate and comparable quality of life in most aspects, except psychological score. And in the in-complete excision patients, administration of post-operative GnRH agonist had a post-treatment improvement of VAS score similar with the complete excision patient (4.5±3.2 versus 5.6±3.9, P=0.272). However, the recurrence rate were still significantly higher (29.4% VS 3.9%, P=0.000).
  
  
  CONCLUSIONS
  Comparing with incomplete excision, the complete excision of DIE significantly decreased the post-operative pain and the recurrence rate. Although incomplete excision with post-operative GnRHa is efficient with respect to pain, the side effects of the drugs and the recurrence rate after cessation of the drugs must be considered. So complete excision of DIE is the first surgical treatment of choice.
authors.affiliation: Department of Gynecology, The Obstetrics and Gynecology Hospital of Fudan UniversityShanghai 200090, China; Shanghai Key Laboratory of Female Reproductive Endocrine Related DiseasesShanghai 200090, China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Cao
authors.affiliation: Department of Gynecology, The Obstetrics and Gynecology Hospital of Fudan UniversityShanghai 200090, China; Shanghai Key Laboratory of Female Reproductive Endocrine Related DiseasesShanghai 200090, China; Department of Obstetrics and Gynecology, Zhongshan Hospital, Fudan UniversityShanghai 200032, China.
authors.forename: Fang
authors.initials: F
authors.lastname: Lu
authors.affiliation: Department of Gynecology, The Obstetrics and Gynecology Hospital of Fudan UniversityShanghai 200090, China; Shanghai Key Laboratory of Female Reproductive Endocrine Related DiseasesShanghai 200090, China.
authors.forename: Wei-Wei
authors.initials: WW
authors.lastname: Feng
authors.affiliation: Department of Gynecology, The Obstetrics and Gynecology Hospital of Fudan UniversityShanghai 200090, China; Shanghai Key Laboratory of Female Reproductive Endocrine Related DiseasesShanghai 200090, China.
authors.forename: Jing-Xin
authors.initials: JX
authors.lastname: Ding
authors.affiliation: Department of Gynecology, The Obstetrics and Gynecology Hospital of Fudan UniversityShanghai 200090, China; Shanghai Key Laboratory of Female Reproductive Endocrine Related DiseasesShanghai 200090, China.
authors.forename: Ke-Qin
authors.initials: KQ
authors.lastname: Hua
keywords: Deep infiltrating endometriosis; complete excision; incomplete excision; laparoscopic surgery