title: Determinant factors of postoperative recurrence of endometriosis: difference between endometrioma and pain.
abstract: OBJECTIVE
  Although the postoperative use of hormonal treatment for endometriosis is recommended in the European Society of Human Reproduction and Embryology guidelines to prevent the recurrence of endometriosis-associated dysmenorrhoea, hormonal treatment may not be necessary for all patients who undergo surgical treatment for endometriosis. The aim of this study was to clarify the determinant factors that predict the recurrence of endometriosis after surgery in order to develop personalized hormonal treatment recommendations. Factors associated with the recurrence of endometrioma and pain were investigated independently to identify the likelihood of recurrence in each individual patient.
  
  
  METHODS
  Between 2008 and 2013, 352 patients underwent surgery and were diagnosed with endometriosis based on pathological findings at the study hospital. Among these patients, 191 experienced a recurrence of endometrioma in the absence of pre- or postoperative hormonal treatment. Various clinical factors such as pre-operative pain, intra-operative findings and postoperative improvement of pain were compared between patients who experienced recurrence after surgery and those who did not.
  
  
  RESULTS
  The cumulative 5-year recurrence rate of endometrioma was 28.7% among the 191 patients who did not undergo pre- or postoperative hormonal treatment. Significant differences were detected in maximum tumour diameter, revised American Society for Reproductive Medicine score (r-ASRM score), operative time and operative blood loss between patients in the recurrent endometrioma group and the non-recurrent endometrioma group; only the r-ASRM score was significantly correlated with recurrence of endometrioma in the multivariate analysis. The cumulative 5-year rate of persistent/recurrent pain was 33.4%. There were significant differences in the postoperative improvement of pain between the persistent/recurrent pain group and the non-recurrent pain group according to the univariate and multivariate analyses.
  
  
  CONCLUSIONS
  This study suggests that the risk factors for recurrence of endometrioma differ from the risk factors for recurrence of pain. The use of postoperative hormonal treatment should be considered based on the dominant risk factors and needs of each patient.
authors: Department of Obstetrics and Gynaecology, Kinki University Faculty of Medicine, Osaka, Japan. Electronic address: tobiume@med.kindai.ac.jp.
authors: T
authors: T
authors: Tobiume
authors: Department of Obstetrics and Gynaecology, Kinki University Faculty of Medicine, Osaka, Japan.
authors: Y
authors: Y
authors: Kotani
authors: Department of Obstetrics and Gynaecology, Kinki University Faculty of Medicine, Osaka, Japan.
authors: H
authors: H
authors: Takaya
authors: Department of Obstetrics and Gynaecology, Kinki University Faculty of Medicine, Osaka, Japan.
authors: H
authors: H
authors: Nakai
authors: Department of Obstetrics and Gynaecology, Kinki University Faculty of Medicine, Osaka, Japan.
authors: I
authors: I
authors: Tsuji
authors: Department of Obstetrics and Gynaecology, Kinki University Faculty of Medicine, Osaka, Japan.
authors: A
authors: A
authors: Suzuki
authors: Department of Obstetrics and Gynaecology, Kinki University Faculty of Medicine, Osaka, Japan. Electronic address: mandai@med.kindai.ac.jp.
authors: M
authors: M
authors: Mandai
mesh_terms: D000328:Adult; D000367:Age Factors; D004715:Endometriosis / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D010049:Ovarian Diseases / Q000175:diagnosis / Q000601:surgery*; D010146:Pain / Q000175:diagnosis*; D011184:Postoperative Period; D012008:Recurrence; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Determinant factors; Endometriosis; Pain; Postoperative hormonal treatment; Recurrence