Recurrence of Ovarian Endometrioma in Adolescents after Conservative, Laparoscopic Cyst Enucleation

Abstract

Study Objective: To evaluate the cumulative recurrence rate of endometriomas after a laparoscopic endometriotic cyst enucleation in adolescents and to find the factors associated with recurrence. Design: A multicenter retrospective cohort study. Setting: Three university hospitals. Participants: One hundred five patients surgically treated with laparoscopic enucleation of endometriotic cysts younger than 20 years of age were selected. Interventions: None. Main Outcome Measures: Endometrioma recurrence was considered when transvaginal or transrectal sonography indicated a cystic mass with a diameter of 20 mm or greater. Recurrence rate of endometrioma and median time to recurrence were evaluated. Results: In total, 105 patients were followed for 47.3 (+/- 44.3) months (range, 3-161 months). Seventeen patients (16.2%) experienced recurrence after the first-line surgery and 8 patients (7%) underwent a second surgery. The median time to recurrence was 53.0 (+/- 8.5) months (range, 8-111 months). Using Kaplan-Meier method, the cumulative recurrence rates of endometrioma per patient at 24, 36, 60, and 96 months after the first-line surgery were 6.4%, 10%, 19.9% and 30.9%, respectively. Surgical characteristics, such as the diameter of the cyst, revised American Society for Reproductive Medicine stage, unilateral or bilateral involvement, and coexistence of deep endometriosis were not associated with recurrence in this age group. Conclusion: Although the short-term recurrence rate in adolescents after first-line surgery is relatively low, the recurrence rate appears to be higher according to the follow-up duration. Long-term and continuous follow-up is needed for patients who have undergone surgical treatment for endometriosis in the adolescent period.