Long-term results after surgical management of rectal endometriosis: 7-year follow-up of patients enrolled in a randomized trial

Goal of the study

To compare functional outcome, recurrence rate, and likelihood of pregnancy in patients undergoing conservative versus radical surgery in patients with deep rectal endometriosis 7 years postoperatively.

Design

Prospective study in a cohort of patients included in a 2-arm randomized trial from March 2011 to August 2013.

Setting

A tertiary referral center.

The patients

55 patients with deep endometriosis infiltrating the rectum.

Speeches

Patients underwent either segmental resection or excision of nodules by shaving or disc excision, according to a randomization carried out preoperatively using sequentially numbered opaque sealed envelopes.

Measurement and main results

The primary endpoint was the number of patients with any of the following symptoms: constipation, frequent bowel movements, anal incontinence or bladder dysfunction 24 months after surgery. The secondary endpoints were the values ​​of the gastrointestinal and global quality of life scores. The 7-year recurrence rates (new deep endometriotic nodule infiltrating the rectum) in the excision arms compared to the segmental resection arms were 7.4% versus 0% (P = 0.24). One or more symptoms included in the definition of the primary endpoints were recorded in 55.6% versus 60.7% of patients (P = 0.79). However, 51.9% versus 53.6% of patients considered their stools normal (P = 0.99). An intention-to-treat comparison of global quality of life scores found no differences between the two groups at 7 years postoperatively. At the end of the 7-year study period, 31 of the 37 patients who tried to conceive were successful (83.8%) including: 27 (57.4%) natural conceptions and 20 (42.6%) pregnancies resulting from ART procedures. The pregnancy rate was 82.4% versus 85% in both arms (P = 0.99). A live birth rate of 75.7% was recorded. At the end of the follow-up there were 15 women with one child (40.5%) and 13 women with 2 children (35.1%). During the 7-year follow-up, the reoperation rate was 37% and 35.7% in each arm, respectively, p = 0.84). Of the 27 reoperation procedures during the follow-up period, 11 were postoperative complications (40.7%), 7 were required before ART management (25.9%), 8 were for pain recurrent abdominal or pelvic injuries (29.6%) and one for a midline ventral hernia. after pregnancy (3.7%).

conclusion

Our study did not reveal a significant difference in terms of digestive functional outcomes, recurrence rate, risk of reoperation and probability of pregnancy when conservative and radical rectal surgery for deep endometriosis was compared 7 years after treatment. operation. The postoperative pregnancy rate observed in our series is high.