Maintenance Therapy for Preventing Endometrioma Recurrence after Endometriosis Resection Surgery - A Systematic Review and Network Meta-analysis

Chui-Ching Chiu; Teh-Fu Hsu; Ling-Yu Jiang; I-San Chan; Ying-Chu Shih; Yen-Hou Chang; Peng-Hui Wang; Yi-Jen Chen

doi:10.1016/j.jmig.2021.11.024

Maintenance Therapy for Preventing Endometrioma Recurrence after Endometriosis Resection Surgery - A Systematic Review and Network Meta-analysis

J Minim Invasive Gynecol. 2022 May;29(5):602-612. doi: 10.1016/j.jmig.2021.11.024. Epub 2022 Feb 2.

Authors

Chui-Ching Chiu¹, Teh-Fu Hsu², Ling-Yu Jiang¹, I-San Chan¹, Ying-Chu Shih¹, Yen-Hou Chang³, Peng-Hui Wang⁴, Yi-Jen Chen⁵

Affiliations

¹ Department of Obstetrics and Gynecology (Drs. Chiu, Jiang, Chan, Shih, Chang, Wang, and Chen); Taipei Veterans General Hospital, School of Medicine, Institute of Clinical Medicine, National Yang Ming Chiao Tung University (all authors); Institute of Clinical Medicine (Drs. Chiu, Jiang, Chan, Shih, Wang, and Chen), National Yang Ming University, Taipei, Taiwan.
² Department of Emergency Medicine (Dr. Hsu); Taipei Veterans General Hospital, School of Medicine, Institute of Clinical Medicine, National Yang Ming Chiao Tung University (all authors).
³ Department of Obstetrics and Gynecology (Drs. Chiu, Jiang, Chan, Shih, Chang, Wang, and Chen); Taipei Veterans General Hospital, School of Medicine, Institute of Clinical Medicine, National Yang Ming Chiao Tung University (all authors).
⁴ Department of Obstetrics and Gynecology (Drs. Chiu, Jiang, Chan, Shih, Chang, Wang, and Chen); Institute of Clinical Medicine (Drs. Chiu, Jiang, Chan, Shih, Wang, and Chen), National Yang Ming University, Taipei, Taiwan.; Taipei Veterans General Hospital, School of Medicine, Institute of Clinical Medicine, National Yang Ming Chiao Tung University (all authors).
⁵ Department of Obstetrics and Gynecology (Drs. Chiu, Jiang, Chan, Shih, Chang, Wang, and Chen); Taipei Veterans General Hospital, School of Medicine, Institute of Clinical Medicine, National Yang Ming Chiao Tung University (all authors); Institute of Clinical Medicine (Drs. Chiu, Jiang, Chan, Shih, Wang, and Chen), National Yang Ming University, Taipei, Taiwan.. Electronic address: chenyj@nycu.edu.tw.

PMID: 35123042
DOI: 10.1016/j.jmig.2021.11.024

Abstract

Objective: To evaluate the efficacy of different hormone therapies in preventing postoperative endometrioma recurrence.

Data sources: The MEDLINE, COCHRANE, and Embase electronic databases were searched from inception to 30 April 2021.

Methods of study selection: Randomized controlled trials (RCTs) or cohort studies including reproductive age women with endometriosis undergoing ovarian cystectomy or excision of endometriotic lesions compared the effects of postoperative adjuvant therapy (gonadotropin-releasing hormone agonist [GnRHa]) and postoperative maintenance hormone interventions for more than 1 year (i.e., oral contraceptive pills [OCPs], dienogest [DNG], levonorgestrel-releasing intrauterine system [LNGIUS]) on endometrioma recurrence.

Tabulation, integration, and results: Data collection and analysis of the data were independently performed 2 two reviewers. A total of 11 studies were included, of which 2 were RCTs, and 9 were cohort studies. There were 2394 patients with 6 interventions (cases: 1665, 69.6%) and expectant management (cases: 729, 30.4%). Relative treatment effects were estimated using network meta-analysis and ranked in descending order. The clinical effectiveness of these drugs (vs expectant management) was as follows: GnRHa plus DNG (odds ratio [OR], 0.04; 95% confidence interval [CI], 0.01-0.27), surface under the cumulative ranking (SUCRA) = 94.0; DNG (OR, 0.11; 95% CI, 0.04-0.32), SUCRA = 69.7; GnRHa plus OCP (OR, 0.12; 95% CI, 0.02-0.64), SUCRA = 63.4; GnRHa plus LNGIUS (OR, 0.13; 95% CI, 0.03-0.66), SUCRA = 59.4; and OCP (OR, 0.21; 95% CI, 0.13-0.36), SUCRA = 43.6. The effectiveness of GnRHa (OR, 0.47; 95% CI, 0.12-1.89), SUCRA = 17.3 was not significantly different from that of controls.

Conclusion: In network meta-analysis, combined postoperative adjuvant therapy and longer maintenance hormone treatment are better than a single agent in preventing postoperative endometrioma recurrence. GnRHa plus DNG maintenance treatment might be the most effective intervention. Large-scale RCTs of these agents are still required.

Keywords: Endometrioma recurrence; Maintenance therapy; Postoperative.

Publication types

Meta-Analysis
Review
Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Contraceptives, Oral, Combined / therapeutic use
Endometriosis* / drug therapy
Endometriosis* / prevention & control
Endometriosis* / surgery
Female
Humans
Network Meta-Analysis
Ovariectomy
Postoperative Period

Substances

Contraceptives, Oral, Combined