A Systematic Review Of Risk Factors For Recurrence Of Endometriosis After Surgery

Objective:Endometriosis is one of the common diseases of women in reproductive period.It is a benign disease,but the behavior is malignant.Drugs and surgery are often used.Recurrence rate is high except radical operation.The risk factors for recurrence of endometriosis after conservative surgery have been determined by analyzing clinical data,observing recurrence and risk analysis.In this study,published data on risk factors for postoperative recurrence of endometriosis were collected for systematic evaluation,and the risk factors for postoperative recurrence of endometriosis after conservative surgery were analyzed using the theory of evidence-based medicine.Therefore,it is helpful to identify and inform patients of the risk factors of recurrence in clinical practice,to detect the risk factors preoperatively and guide the prognosis of patients,and to increase the success rate of treatment by improving preoperative evaluation.Methods:PubMed,EMBASE,Cochrane Library,Chinese National Knowledge Infrastructure(CKNI),Wanfang database and Vip database were searched by computer.All the research reports that could be retrieved were retrieved by hand.The retrieval time was from the database establishment to October,2018.Literature screening,quality evaluation and data extraction were performed independently according to predetermined criteria.Meta-analysis was performed using RevMan5.3 software.Results:A total of 24 studies were included in this meta-analysis.Including 19 retrospective cohort studies(5342 cases)and 5 prospective cohort studies(1613 cases).The quality of literatures was evaluated using the NewcastleOttawa Scale(NOS)of cohort study.The NOS score of the included literatures was 6-8.The results of meta-analysis showed that there was a significant difference in postoperative recurrence rate between exposure group and nonexposure group who got high rAFS stage(RR=1.87,95%CI[1.55,2.26],P< 0.00001).The postoperative recurrence rate was significantly different between the exposed group and non-exposed group who got painful nodules in Douglas pouch(RR = 3.31,95%CI [2.55,4.28],P <0.00001).Postoperative recurrence rates were significantly different between the exposed group and non-exposed group with dysmenorrhea(RR = 1.77,95%CI [1.43,2.20],P< 0.00001).The postoperative recurrence rate was significantly different between the exposed group and non-exposed group with adenomyosis(RR=1.48,95% CI[1.15,1.91],P=0.002).There was a significant difference in surgical age between the relapsed group and non-relapsed group(MD =-2.18,95%CI [-2.83,-1.52],P<0.00001).Postoperative recurrence rate was significantly different between the exposed group and non-exposed group in terms of postoperative pregnancy(RR=0.36,95%CI [0.27,0.48],P<0.00001).There was no significant difference in postoperative recurrence rate between the exposed group and the non-exposed group with infertility(RR=0.95,95%CI[0.76,1.19],P =0.67).There was no significant difference in BMI between the two groups(MD=-0.20,95%CI [-0.58,0.19],P =0.31).Conclusions:1.Among the factors related to the recurrence of endometriosis after conservative surgery,younger surgical age,higher rAFS stage,painful nodules in Douglas pouch,dysmenorrhea,and adenomyosis are the risk factors of postoperative recurrence.2.Postoperative pregnancy is a protective factor for postoperative recurrence.For patients with fertility requirements,try to get pregnant as soon as possible after surgery.3.Infertility and BMI had no significant effect on postoperative recurrence.