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• W4205941494 abstract "Endometriosis is a disease of gynecologic origin, but its various localizations might lead to digestive and urinary tract, pelvic nerve, or diaphragm involvement. Ovarian endometrioma (OMA), one of the most frequent localizations of the gynecologic tract, is frequently associated with various superficial or deep endometriosis lesions. A randomized trial included a nonpostoperative hormonal treatment patient group and revealed the rate of recurrence after cyst excision to be as high as 29% as early as 24 months after surgery (1Seracchioli R. Mabrouk M. Frascà C. Manuzzi L. Montanari G. Keramyda A. et al.Long-term cyclic and continuous oral contraceptive therapy and endometrioma recurrence: a randomized controlled trial.Fertil Steril. 2010; 93: 52-56Google Scholar). Surgical procedures for OMA are among the most frequent procedures in patients with endometriosis. The choice of surgical technique should be individualized and should take into account factors such as a woman’s age, pregnancy intention, cyst features, ovarian reserve, fallopian tube patency, and recurrent status. Surgeons may choose to remove an OMA using excision or cystectomy, destroy it in situ by vaporization using laser or plasma energy, coagulate the inner layer of OMA using bipolar current, destroy it using sclerotherapy, or simply drain it (2Miller C.E. The endometrioma treatment paradigm when fertility is desired: a systematic review.J Minim Invasive Gynecol. 2021; 28: 575-586Google Scholar). These techniques may also be concomitantly performed in a unique patient with multiple OMAs. Performing oophorectomy rather than cystectomy in women with no further pregnancy intention may be advocated in cases of a high recurrence risk. However, performing bilateral oophorectomy is now disputed in nonmenopausal women based on the evidence of long-term unfavorable consequences. Deciding on the best technique for a patient requires knowledge of not only endometriosis but also human reproduction. An OMA in a patient with a high likelihood of natural conception after surgery cannot be treated similarly to an OMA in a patient presenting with a formal indication for in vitro fertilization due to hydrosalpinx or sperm alteration. Choosing the best OMA treatment is probably one of the most challenging decisions in endometriosis surgery; this is in addition to OMA management, frequently performed concomitantly with the management of other severe localizations. Clinical research in the field of surgery can be based on data collected by ≥1 surgical teams or by nationwide databases. The first type of clinical research might be prospective or retrospective, interventional or observational, and focusing on only patients recruited at a single or a limited number of centers, thus reflecting team specificity and expertise in the management of the disease. These studies usually involve a large number of variables or items related to a specific disease or endpoint. This list of variables might vary after the introduction of a new technique, wherein surgeons wish to assess its efficacy or make comparisons with other procedures. Although these studies provide information on the efficacy, risks, and outcomes of surgical procedures, they also tend to report the best expected outcomes because majority of their data comes from centers with extensive experience in the management of the disease. Therefore, caution is required while extrapolating such results to daily practice, with more inexperienced teams being less likely to observe similar results. Thus, in a series of patients managed for OMA at a university tertiary referral center, the open surgery rate was 0.8%, deep endometriosis nodules were removed in 84% of patients, and surgical procedures on the digestive and urinary tracts were recorded in 45% and 11%, respectively, of women; however, the postoperative pregnancy rate exceeded 60%, with most conceptions being spontaneous (3Roman H. Quibel S. Auber M. Muszynski H. Huet E. Marpeau L. et al.Recurrences and fertility after endometrioma ablation in women with and without colorectal endometriosis: a prospective cohort study.Hum Reprod. 2015; 30: 558-568Google Scholar). At centers with a lower surgical volume, the risk of conversion to open surgery in severe cases is notably higher, with an associated reduction in pregnancy and spontaneous conception rates. Conversely, studies using data from a national database may allow a more accurate reflection of a nationwide situation, such as the prevalence of the disease, number of patients treated, and overall number of procedures performed over a specific time period nationally. Although such conclusions are useful for drawing up health policies and assessing treatment needs across a country, they cannot provide the basis for changes in practice at a tertiary-level referral center, particularly because a nationwide database tends to focus on a limited number of items for a certain disease or its management. As a result, more recent surgical techniques or those used on a less frequent basis are likely to be overlooked, and related data are likely to be wrongly recorded based on data from a set list of techniques. Furthermore, the data on the assessment or discussion of the treatment choice are less. In the case of OMA management, it is not possible to ascertain whether the decision to perform oophorectomy is based on intraoperative technical constraints, based on suspected cancer of the ovary, or because the patient is postmenopausal. No information has been provided on whether patients additionally undergo complete excision of other lesions after oophorectomy or whether the lesions are left untreated to avoid a possible increased risk of morbidity associated with the complex surgery. The reasons that lead to conversion to open surgery remain unknown. Thus, nationwide database results greatly differ from those reported by experienced teams. Orlando et al. (4Orlando M.S. Yao M. Chang O.H. Shippey E. Bosko T. Cadish L. et al.Perioperative outcomes in a nationwide sample of patients undergoing surgical treatment of ovarian endometriomas.Fertil Steril. 2022; 117: 444-453Google Scholar) recently performed an important nationwide database-based evaluation of perioperative outcomes in premenopausal women undergoing cystectomy or oophorectomy for OMA and other benign ovarian cysts using data from the Vizient clinical database, which collects information from 580 different centers across the United States. The study provided clear details regarding the treatment process in patients presenting with endometriosis with ovary involvement at a hospital participating in the database, which are useful for the assessment of overall treatment costs. These results naturally differ from those provided by tertiary referral centers. However, an analysis of the extent of these differences in the results might provide useful information for developing teaching and training courses for gynecologic surgeons who focus on improving the overall treatment of endometriosis in the US population. Perioperative outcomes in a nationwide sample of patients undergoing surgical treatment of ovarian endometriomasFertility and SterilityVol. 117Issue 2PreviewTo evaluate the perioperative outcomes of premenopausal women undergoing cystectomy or oophorectomy for ovarian endometriomas (OMAs) and other benign neoplasms. Full-Text PDF" @default.
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• W4205941494 title "Endometriosis in studies based on nationwide databases" @default.
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• W4205941494 doi "https://doi.org/10.1016/j.fertnstert.2021.12.005" @default.
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