Analysis of the predictive factors for the recurrence of deep infiltrating endometriosis: A 2-year prospective study

• Main Authors: Yun-Xi Zheng, Qi Cheng, Kai-Kai Chang, Jing-Yao Ruan, Qi Tian, Shou-Xin Gu, Yun Chen, Xiao-Fang Yi
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2019-01-01
• Series: Reproductive and Developmental Medicine
• Subjects: deep infiltrating endometriosis; laparoscopic surgery; recurrence; revised american fertility society stage; visual analog scale
• Online Access: http://www.repdevmed.org/article.asp?issn=2096-2924;year=2019;volume=3;issue=4;spage=213;epage=221;aulast=Zheng
• ISSN: 2096-2924; 2589-8728

Objective: To investigate factors that may be associated with the recurrence of deep infiltrating endometriosis (DIE) and DIE-related symptoms. Methods: Starting in September 2014, women with a confirmed diagnosis of DIE based on surgical and histological findings were included in the prospective study with a 2-year follow-up in our hospital. A total of 84 consecutive patients were included, all of whom underwent laparoscopic surgery. The data were obtained from the medical records of the patients. Follow-up data, including presence of pain as assessed using the visual analog scale (VAS) score and ultrasonography/magnetic resonance imaging findings, were obtained at 3, 6, 9, 12, and 24 months postoperatively. Variables, such as age, body mass index, severity and duration of symptoms, size and location of the lesion, and pre- and postoperative medical treatment, were evaluated using univariate and multivariate analyses to identify factors correlated to recurrence. Results: A total of 11 (13.1%) patients presented with recurrence, with a mean time to recurrence of 14.2 months. The univariate analysis showed that the longer duration of menstruation (7.4 vs. 6.0, P = 0.010), the more advanced revised American Fertility Society (rAFS) stage (Stages I and II vs. III and IV, χ2 = 9.964, P = 0.001), the higher VAS score for dysmenorrhea (9.4 vs. 5.2, P = 0.001), and the more severe pain during defecation (7.8 vs. 4.8, P = 0.016) were positively correlated to DIE recurrence. However, the multivariate analysis also revealed that a more severe dysmenorrhea and advanced rAFS stage were the independent factors associated with the recurrence of DIE, with an odds ratio of 1.895 (confidence interval [CI]: 1.061–3.385, P = 0.031) and 4.310 (CI: 1.091–17.028, P = 0.037), respectively. Conclusions: More than 10% of patients presented with recurrence of DIE 2 years after surgery. Recurrence of DIE was more common in patients who complained of more severe dysmenorrhea and had an advanced rAFS stage.