Earlier Endometrioma Recurrence With Laser Vaporization

NEW YORK (Reuters Health) May 27 - Ovarian endometrioma recurs earlier and more often after laser vaporization than after laparoscopic cystectomy, although the differences aren't statistically significant at five years, according to a new study.

"Currently, we are using both techniques with a preference for the stripping," Dr. Francisco Carmona from University of Barcelona told Reuters Health in an e-mail.

The study findings were published online May 16 in Fertility and Sterility.

Disease recurrence after surgery is "one of the most frustrating aspects of treating endometrioma," the clinicians note in their report. Depending on the surgical approach and follow up time, between 10% and 50% of women will have a recurrence after 2 to 5 years.

Dr. Carmona and colleagues say their study is the first randomized prospective trial comparing laser vaporization with cystectomy in terms of long-term recurrence rates.

The study enrolled 90 women with ovarian endometriomas and similar baseline clinical and ultrasound findings. Half were assigned to cystectomy and half to laser vaporization.

Nine women in the cystectomy group and seven in the laser vaporization group were excluded, leaving 36 and 38, respectively, for the final analysis. There were no conversions to laparotomy or complications during or after surgery in either group.

Recurrences happened earlier in the laser group than in the cystectomy group (7.5 vs 18.1 months); thus, the recurrence rate at 12 months was statistically higher (P = 0.04) in the laser group (12 of 38 patients; 31.6%) than in the cystectomy group (4 of 36 patients; 11%).

At five years, the endometrioma recurrence rate continued to be higher in the laser group but the difference was no longer significant: 8 of 36 laser-treated patients (22%) had recurrence vs 14 of 38 cystectomy patients (37%).

Another study had recently suggested that oral contraceptives may protect against endometrioma recurrence, the authors note, but in this trial the recurrence rate at five years was similar in women who did or did not use them after surgery (29% vs 30%, respectively).

The investigators say laser vaporization has been proposed as the best method to preserve ovarian function. Yet they found no differences in pregnancy rates at one and five years in women who wanted to become pregnant. At one year, pregnancy rates were 19.2% and 20.8% in the cystectomy and laser groups, respectively. At five years, these rates were 38.1% and 44.4%, respectively.

The two approaches are "fairly equivalent when you are looking at the long term; however, it is noteworthy that recurrences were earliest in the laser group," Dr. Carmona commented in an e-mail to Reuters Health.

Dr. Carmona also mentioned that the study wasn't designed to look at cost or side effect differences. "However," he said, "there were not side effect differences between groups in terms of hospital stay or surgical complications."

The study was supported in part by Olympus Europe Holding.

SOURCE: http://bit.ly/lIHblZ

Fertil Steril 2011.