Is there any advantage of addition of hysterectomy on deep endometriotic pelvic pain or on the quality of life?

The addition of hysterectomy provides greater benefit than excision alone for deep endometriotic pelvic pain and the quality of life.

Key Points

Importance:

• Although it is well known that surgery is the treatment, there is no consensus on the optimal surgical approach for pain associated with deep endometriosis.

Highlights:

• The addition of hysterectomy and salpingo-oophorectomy provides a substantial advantage compared to excision surgery alone for non-cyclical pelvic pain and the quality of life.

What's done here:

• This is a prospective controlled study examining the addition of hysterectomy and salpingo-oophorectomy during laparoscopic excision surgery for deep infiltrating endometriosis. 
• The study included 220 patients that underwent excision surgery (EES) with (n=100 patients) or without a hysterectomy and bilateral salpingo-oophorectomy (n=120)  in a single endometriosis center.
• The preoperative and postoperative alterations of premenstrual pain, menstrual pain, non-cyclical pelvic pain, deep dyspareunia, cyclical dyschezia, non-cyclical dyschezia, lower back pain, bladder pain, pain during bladder voiding, and quality of life were compared.
• The quality of life, and pain scores before and at 6, 12, and 24 months after the surgeries were the main outcomes.
• The presence of adenomyosis was also assessed by blinded re-analyses of imaging and/or histologic data. 

Key Results:

• The comparison of outcomes of the two types of surgeries showed that improvement in non-cyclical pelvic pain was higher with the addition of hysterectomy and salpingo-oophorectomy.
• The statistical evaluation also showed an advantage for dyspareunia, non-cyclical dyschezia, and bladder pain for this group of patients. 
• The improvement of the quality of life scores was also superior in this group.

Lay Summary

 The addition of hysterectomy and salpingo-oophorectomy to the endometriosis excision surgery provided greater benefits when compared to excision surgery alone, according to the results of a comparison study that was recently published in the journal named "Facts Views and Visions in Obstetrics and Gynecology". There was an improvement in the pain symptoms and the quality of life scores of the patients when organ surgery is added, compared to those who had excision-only surgeries.

 Recommended surgical treatment for endometriosis is usually a laparoscopic or robotic excision of visible endometriotic lesions while preserving the uterus and adnexa. Patients who deserve more radical treatments, including removal of the uterus, cervix, bilateral tubes, and ovaries, caused a hypoestrogenic state and amenorrhea. The concern is whether the hypoestrogenic state is worthy of preference for improving pelvic pains and quality of life.

To reveal the effectiveness of removing the uterus and adnexa for reducing pain symptoms and improving the quality of life,  Manobharath et al. from the University College London Medical School, United Kingdom, set up a prospective study on 100 cases with additional hysterectomy and salpingo-oophorectomy surgeries and 120 controls. Clinical symptoms such as premenstrual pain, menstrual pain, non-cyclical pelvic pain, deep dyspareunia, cyclical dyschezia, non-cyclical dyschezia, lower back pain, bladder pain, pain during bladder voiding, and the quality of life scores were collected preoperatively and 6, 12, and 24 months postoperatively.

The mean preoperative symptom scores were significantly greater in the organ resection group compared to the excision alone group for premenstrual pain, non-cyclical pelvic pain, deep dyspareunia, and emptying the bladder in 6, 12, and 24 months follow-ups.

"These results must be weighed against the complication rates and reproductive and hormonal side-effects on an individual basis." the authors added.

Research Source: https://pubmed.ncbi.nlm.nih.gov/37010333/