Surgical Treatment of Endometriosis Has Poor 1-Year Outcome, Study Shows

Surgical Treatment of Endometriosis Has Poor 1-Year Outcome, Study Shows

Researchers found that treatment of endometriosis by completely or partially removing the uterus (hysterectomy) or removing lesions via laparoscopy surgery can promote very different outcomes.

Surgical treatment of endometriosis can have great implications in the quality of life of patients, as it is associated with serious surgical complications and increased administration of painkillers, according to a study published in the journal Advances in Therapy.

Despite many efforts, no cure has been discovered for endometriosis. Treatments are focused on symptom management, based on drug therapies to reduce pain and hormones to manage endometriosis-associated infertility. However, surgery remains the more effective treatment strategy shown to improve fertility and manage pain in patients who do not respond to pharmacological treatments.

Laparoscopy surgery is the most commonly used strategy to remove endometriotic lesions and to achieve pain relief. But 30 to 50 percent of treated patients experience disease recurrence within 5 years, requiring additional surgical treatment for symptom management.

In more severe cases, hysterectomy and removal of the ovaries and the fallopian tubes can be considered as alternative treatment. However, inconsistent outcome reports on this less-conservative surgical approach have raised several questions about its overall benefits for patients.

In the study “Treatment Patterns, Complications, and Health Care Utilization Among Endometriosis Patients Undergoing a Laparoscopy or a Hysterectomy: A Retrospective Claims Analysis,” a research team led by Bowdoin Su, MD, associate medical director of medical affairs at AbbVie, evaluated the outcome within 1 year of follow-up of patients who underwent hysterectomy and laparoscopy surgery for treating endometriosis.

The researchers analyzed clinical information of 62,223 women who underwent surgical treatment for endometriosis between 2004 and 2013. The data was collected from the Truven Health Analytics Marketscan Commercial Claims and Encounters (CCAE) database.

After analysis of the information regarding medications prescribed, reported complications and hospitalizations during the immediate year after the surgical treatment, researchers found significant differences between the women who underwent hysterectomy and laparoscopy.

Women who received laparoscopy were more likely to initiate hormone therapy with GnRH agonist, progestin, Danocrine (danazol), or to take opioid analgesic compared to women who underwent a hysterectomy. In contrast, hysterectomy was associated with higher incidence of complications.

Overall the team concluded that endometriosis patients included in the analysis had a higher risk of experiencing surgical complications, subsequent surgeries, and hospital admissions, both during and after their initial therapeutic laparoscopy or hysterectomy.

“The results of this study suggest that better nonsurgical treatments could potentially improve patient outcomes and the quality of life of millions of American women,” the researchers wrote.

5 comments

  1. Of course surgery has a high failure rate when the endometriosis is not completely removed.

    Big difference between recurrence and persistence of untreated disease.

    What they also fail to mention is that no hormone therapy has ever been shown to actually treat endometriosis. Studies evaluating endometriosis focus on “endometriosis related pain” and symptoms. Per ACOG “there are no data that show hormones prevent progression of endometriosis.” In other words, hormone therapies including Abbvie’s GnRH line are only palliative. They may mask the symptoms while the patient is taking the hormone, but the disease may still be progressing internally and causing destruction.

  2. Heather says:

    I am so surprised that an industry-sponsored paper drew industry-favorable results, and with their new drug in the pipeline, no less. But seriously…”30 to 50% of treated patients experience disease recurrence within 5 years, requiring additional surgical treatment for symptom management.” — Stats drawn from (largely underpowered) studies involving ablation – not excision. As Dr Arrington correctly asserts above, there is a tremendous difference between true recurrence and persistence of disease. Excision (*actual* excision) combined with multidisciplinary adjuncts are associated with lower recurrence and better, long-term outcomes (improved/restored fertility, symptomatic relief, etc. etc.) and do not depend on the hormonal manipulation/suppression+poor surgery approach that invariably leads to the vicious repeat surgery/drug therapy/needless hysterectomy circle. Though definitive/universal cure may be elusive, there is a better way to treat endometriosis than the latter; if we keep doing what we’ve always done, we will keep getting what we’ve always gotten. One’s inability to treat the disease effectively is not synonymous with a lack of effective treatments for the disease.

  3. nancy petersen says:

    What an awful article. Poor surgery results in poor outcomes. Drugs do not treat, nor stop the progression of endo. Sadly such misinformation misleads many.

  4. Casey says:

    Hmmm, “a research team led by Bowdoin Su, MD, associate medical director of medical affairs at AbbVie,” finds that new medications need to be developed to find better patient outcomes??? I’m sorry, are we not at all concerned that Abbvie profits from these findings? How can the can the author of this article not even mention the conflict of interests here on the part of Abbvie?

  5. Ken Sinervo says:

    The study also fails to evaluate how the endometriosis was treated surgically. If broken down by ablation and excision, I am sure that the results would show significantly less patients requiring additional surgery, hysterectomy and need for additional medical treatments. It is a bit of a farce to lump together all forms of treatment since they have very different outcomes. As well, hormonal suppression can lead to delayed diagnosis and result in progression of the disease which often requires more extensive surgery because of the perception of disease that there should be little progression, when the opposite may be true.
    The only reassuring thing is that there are some studies looking at women’s health issues, when this often goes ignored.

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