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Patient Quality of Life and Symptoms after Surgical Treatment for Endometriosis

Published:August 20, 2018DOI:https://doi.org/10.1016/j.jmig.2018.08.005

      Abstract

      Study Objective

      To assess the impact of surgical treatment of endometriosis on quality of life and pain over a 3-year period of postoperative follow-up.

      Design

      Prospective and multicenter cohort study (Canadian Task Force classification II-2).

      Setting

      Five districts including a tertiary referral center and private and general public hospitals.

      Patient

      Patients (n = 981), aged 15 to 50years, underwent laparoscopic treatment (preferred approach) for endometriosis between January 2004 and December 2012.

      Intervention

      Laparoscopic treatment for endometriosis. All revised American Fertility Society stages were included.

      Measurements and Main Results

      The mean visual analog scale score for dysmenorrhea fell from 5.3 ± 3.7 (time 0) to 2.6 ± 3.3 at 6 months, and 2.3 ± 3.3 at 36 months of follow-up (p <.001). Mean visual analog scale scores for chronic pelvic pain and dyspareunia fell from 2.6 ± 3.5 and 2.7 ± 3.2, respectively, before surgery to 1.4 ± 2.5 and 1.1 ± 2.2 at 6 months and then 1.3 ± 2.5 and 1.2 ± 2.3 at 36 months of follow-up. The Short Form 36-Item survey analysis revealed the greatest increases linked to physical domains (i.e., bodily pain and role limitations) from 54.6 ± .9 and 63.3 ± 1.3, respectively, at time 0 to 74.4 ± .9 and 81.9 ± 1.1 at 6 months of follow-up (p <.001), with scores subsequently remaining stable. Among mental domains the most favorable results involved social functioning and role limitations due to emotional problems, which increased from 66 ± .8 and 65.7 ± 1.3 at time 0 to 75.6 ± .9 and 77.4 ± 1.3 at 6 months of follow-up, respectively (p <.001), with scores remaining stable over time.

      Conclusions

      Surgical treatment of endometriosis improves pelvic and sexual pain postoperatively in many women with endometriosis. Improvement later plateaus and remains stable, allowing patients to experience the beneficial effects over a period of years.

      Keywords

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      References

        • Hogg S
        • Vyas S
        Endometriosis.
        Obstet Gynaecol Reprod Med. 2015; 25: 133-141
        • Bourdel N
        • Alves J
        • Pickering G
        • Ramilo I
        • Roman H
        • Canis M
        Systematic review of endometriosis pain assessment: how to choose a scale?.
        Hum Reprod Update. 2015; 21: 136-152
        • Garry R
        • Clayton R
        • Hawe J
        The effect of endometriosis and its radical laparoscopic excision on quality of life indicators.
        Br J Obstet Gynaecol. 2000; 107: 44-54
        • Friedl F
        • Riedl D
        • Fessler S
        • et al.
        Impact of endometriosis on quality of life, anxiety, and depression: an Austrian perspective.
        Arch Gynecol Obstet. 2015; 292: 1393-1399
        • Fourquet J
        • Baez L
        • Figueroa M
        • Iriarte RI
        • Flores I
        Quantification of the impact of endometriosis symptoms on health-related quality of life and work productivity.
        Fertil Steril. 2011; 96: 107-112
        • Fourquet J
        • Gao X
        • Zavala D
        • et al.
        Patients' report on how endometriosis affects health, work, and daily life.
        Fertil Steril. 2010; 93: 2424-2428
        • Kent A
        • Shakir F
        • Rockall T
        • et al.
        Laparoscopic surgery for severe rectovaginal endometriosis compromising the bowel: a prospective cohort study.
        J Minim Invasive Gynecol. 2016; 23: 526-534
        • Chauvet P
        • Auclair C
        • Mourgues C
        • Canis M
        • Gerbaud L
        • Bourdel N
        Psychometric properties of the French version of the Endometriosis Health Profile-30, a health-related quality of life instrument.
        J Gynecol Obstet Hum Reprod. 2017; 46: 235-242
        • Nnoaham KE
        • Hummelshoj L
        • Webster P
        Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries.
        Fertil Steril. 2011; 96: 366-373
        • Kruse C
        • Seyer-Hansen M
        • Forman A
        Diagnosis and treatment of rectovaginal endometriosis: an overview.
        Acta Obstet Gynaecol Scand. 2012; 91: 648-657
        • Roman H
        Guidelines for the management of painful endometriosis.
        JGynecol Obstet Biol Reprod. 2007; 36: 141-150
        • Busacca M
        • Fedele L
        • Bianchi S
        • et al.
        Surgical treatment of recurrent endometriosis: laparotomy versus laparoscopy.
        Hum Reprod. 1998; 13: 2271-2274
        • Duffy JM
        • Arambage K
        • Correa FJ
        • et al.
        Laparoscopic surgery for endometriosis.
        Cochrane Database Syst Rev. 2014; CD011031
        • Bourdel N
        • Comptour A
        • Bouchet P
        • et al.
        Long-term evaluation of painful symptoms and fertility after surgery for large recto-vaginal endometriosis nodule involving at least the serosa of the rectum: a retrospective study.
        Acta Obstet Gynaecol Scand. 2018; 97: 158-167
        • Valentin L
        • Canis M
        • Pouly JL
        • et al.
        SF-36 preoperative interest of predicting improvement of quality of life after laparoscopic management of minimal endometriosis.
        J Gynecol Obstet Hum Reprod. 2017; 46: 137-142
        • Mabrouk M
        • Montanari G
        • Guerrini M
        • et al.
        Does laparoscopic management of deep infiltrating endometriosis improve quality of life? A prospective study.
        Health Qual Life Outcomes. 2011; 9: 98
        • Ribeiro PA
        • Sekula VG
        • Abdalla-Ribeiro HS
        • et al.
        Impact of laparoscopic colorectal segment resection on quality of life in women with deep endometriosis: one year follow-up.
        Qual Life Res. 2014; 23: 639-643
        • Vercellini P
        • Aimi G
        • Busacca M
        • et al.
        Laparoscopic uterosacral ligament resection for dysmenorrhea associated with endometriosis: results of a randomized, controlled trial.
        Fertil Steril. 2003; 80: 310-319
        • Touboul C
        • Ballester M
        • Dubernard G
        • Zilberman S
        • Thomin A
        • Darai E
        Long-term symptoms, quality of life, and fertility after colorectal resection for endometriosis: extended analysis of a randomized controlled trial comparing laparoscopically assisted to open surgery.
        Surg Endosc. 2015; 29: 1879-1887
        • Bassi MA
        • Podgaec S
        • Jr Dias JA
        • D'Amico Filho N
        • Petta CA
        • Abrao MS
        Quality of life after segmental resection of the rectosigmoid by laparoscopy in patients with deep infiltrating endometriosis with bowel involvement.
        J Minim Invasive Gynecol. 2011; 18: 730-733
        • Darai E
        • Dubernard G
        • Coutant C
        • Frey C
        • Rouzier R
        • Ballester M
        Randomized trial of laparoscopically assisted versus open colorectal resection for endometriosis: morbidity, symptoms, quality of life, and fertility.
        Ann Surg. 2010; 251: 1018-1023
        • Abbott JA
        • Hawe J
        • Clayton RD
        • Garry R
        The effects and effectiveness of laparoscopic excision of endometriosis: a prospective study with 2–5 year follow-up.
        Hum Reprod. 2003; 18: 1922-1927
        • Silveira da Cunha Araujo R
        • Abdalla Ayroza Ribeiro HS
        • Sekula VG
        • da Costa Porto BT
        • Ayroza Galvao Ribeiro PA
        Long-term outcomes on quality of life in women submitted to laparoscopic treatment for bowel endometriosis.
        J Minim Invasive Gynecol. 2014; 21: 682-688
        • Bourdel N
        • Roman H
        • Mage G
        • Canis M
        Surgery for the management of ovarian endometriomas: from the physiopathology to the pre-, peri- and postoperative treatment.
        Gynecol Obstet Fertil. 2011; 39: 709-721
        • Kondo W
        • Bourdel N
        • Tamburro S
        • et al.
        Complications after surgery for deeply infiltrating pelvic endometriosis.
        BJOG. 2011; 118: 292-298
        • Bourdel N
        • Cognet S
        • Canis M
        • et al.
        Laparoscopic ureteroneocystostomy: be prepared!.
        J Minim Invasive Gynecol. 2015; 22: 827-833
        • Aaronson NK
        • Acquadro C
        • Alonso J
        • et al.
        International Quality of Life Assessment (IQOLA) project.
        Qual Life Res. 1992; 1: 349-351
        • Leplege A
        • Ecosse E
        • Verdier A
        • Perneger TV
        The French SF-36 health survey: translation, cultural adaptation and preliminary psychometric evaluation.
        J Clin Epidemiol. 1998; 51: 1013-1023
        • Stull DE
        • Wasiak R
        • Kreif N
        • et al.
        Validation of the SF-36 in patients with endometriosis.
        Qual Life Res. 2014; 23: 103-117
        • Verbeke G
        • Molenberghs G
        Linear Mixed Models for Longitudinal Data.
        Springer, New York, NY2000
        • Feise RJ.
        Do multiple outcome measures require p-value adjustment.
        BMC Med Res Methodol. 2002; 2: 8
        • Laursen BS
        • Bajaj P
        • Olesen AS
        • Delmar C
        • Arendt-Nielsen L
        Health related quality of life and quantitative pain measurement in females with chronic non-malignant pain.
        Eur J Pain. 2005; 9: 267-275
        • Touboul C Amate P
        • Ballester M
        • Bazot M
        • Fauconnier A
        • Darai E
        Quality of life assessment using EuroQOL EQ-5D questionnaire in patients with deep infiltrating endometriosis: the relation with symptoms and locations.
        Int J Chronic Dis. 2013; 2013452134
        • Meuleman C
        • Tomassetti C
        • D'Hoore A
        • et al.
        Surgical treatment of deeply infiltrating endometriosis with colorectal involvement.
        Hum Reprod Update. 2011; 17: 311-326
        • Dubernard G
        • Rouzier R
        • David-Montefiore E
        • Bazot M
        • Darai E
        Use of the SF-36 questionnaire to predict quality-of-life improvement after laparoscopic colorectal resection for endometriosis.
        Hum Reprod. 2008; 23: 846-851
        • Lövkvist L
        • Boström P
        • Edlund M
        • Olovsson M
        Age-related differences in quality of life in swedish women with endometriosis.
        J Womens Health. 2016; 25: 646-653
        • Jones G
        • Kennedy S
        • Barnard A
        • Wong J
        • Jenkinson C
        Development of an endometriosis quality-of-life instrument: the Endometriosis Health Profile-30.
        Obstet Gynecol. 2001; 98: 258-264
        • Jones G
        • Jenkinson C
        • Kennedy S
        Evaluating the responsiveness of the Endometriosis Health Profile Questionnaire: the EHP-30.
        Qual Life Res. 2004; 13: 705-713
        • Meuleman C
        • D'Hoore A
        • Van Cleynenbreugel B
        • Beks N
        • D'Hooghe T
        Outcome after multidisciplinary CO2 laser laparoscopic excision of deep infiltrating colorectal endometriosis.
        Reprod Biomed Online. 2009; 18: 282-289
        • Ware JE
        • Snow KK
        • Kosinski M
        • et al.
        SF-36 Health Survey: Manual and Interpretation Guide.
        Lincoln, RI: Quality Metric, Inc, 1993
      1. Nunes FR, Ferreira JM, Bahamondes L. Prevalence of fibromyalgia and quality of life in women with and without endometriosis. Gynecol Endocrinol. 2014;30:307–310.