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Conservative surgery versus colorectal resection for endometriosis with rectal involvement: a systematic review and meta-analysis of surgical and long-term outcomes

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

The optimal surgical approach for removal of colorectal endometrial deposits is unclear. Shaving and discoid excision of colorectal deposits allow organ preservation but risk recurrence with associated functional issues and re-operation. Formal resection risks potential higher complications but may be associated with lower recurrence rates. This meta-analysis compares peri-operative and long-term outcomes between conservative surgery (shaving and disc excision) versus formal colorectal resection.

Methods

The study was registered with PROSPERO. A systematic search was performed on PubMed and EMBASE databases. All comparative studies examining surgical outcomes in patients that underwent conservative surgery versus colorectal resection for rectal endometrial deposits were included. The two main groups (conservative versus resection) were compared in three main blocks of variables including group comparability, operative outcomes and long-term outcomes.

Results

Seventeen studies including 2861 patients were analysed with patients subdivided by procedure: colorectal resection (n = 1389), shaving (n = 703) and discoid excision (n = 742). When formal colorectal resection was compared to conservative surgery there was lower risk of recurrence (p = 0.002), comparable functional outcomes (minor LARS, p = 0.30, major LARS, p = 0.54), similar rates of postoperative leaks (p = 0.22), pelvic abscesses (p = 0.18) and rectovaginal fistula (p = 0.92). On subgroup analysis, shaving had the highest recurrence rate (p = 0.0007), however a lower rate of stoma formation (p < 0.00001) and rectal stenosis (p = 0.01). Discoid excision and formal resection were comparable.

Conclusion

Colorectal resection has a significantly lower recurrence rate compared to shaving. There is no difference in complications or functional outcomes between discoid excision and formal resection and both have similar recurrence rates.

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Data availability

The data that support the findings of this study are available on request from the corresponding author, [SM].

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Authors and Affiliations

  1. Department of Colorectal Surgery, Tallaght University Hospital, Dublin 24, Ireland

    Luke O’Brien, Stefan Morarasu, Paul C. Neary & Cillian Clancy

  2. 2nd Department of Surgical Oncology, Regional Institute of Oncology, Iasi, Romania

    Stefan Morarasu, Ana Maria Musina, Natalia Velenciuc, Cristian Ene Roata, Mihail Gabriel Dimofte & Sorinel Lunca

  3. Grigore T Popa, University of Medicine and Pharmacy, Iasi, Romania

    Stefan Morarasu, Bianca Codrina Morarasu, Ana Maria Musina, Natalia Velenciuc, Cristian Ene Roata, Mihail Gabriel Dimofte & Sorinel Lunca

  4. Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy

    Diego Raimondo, Renato Seracchioli & Paolo Casadio

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  1. Luke O’Brien
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Contributions

All authors contributed to the study conception and design. Luke O’Brien, Stefan Morarasu, Cillian Clancy, Paul C Near, Mihail Gabriel Dimofte, Sorinel Lunca designed the study and approved the study protocol. Luke O’Brien, Stefan Morarasu, Bianca Codrina Morarasu, Ana Maria Musina, Natalia Velenciuc, Cristian Ene Roata performed the literature search. Luke O’Brien, Stefan Morarasu, Cillian Clancy analysed the data. Luke O’Brien, Stefan Morarasu, Cillian Clancy, Bianca Codrina Morarasu, Ana Maria Musina, Natalia Velenciuc, Cristian Ene Roata, Diego Raimondo, Renato Seracchioli, Paolo Casadio prepared the manuscript. Diego Raimondo, Renato Seracchioli and Paolo Casadio provided raw patient data for subgroup analysis. Cillian Clancy, Paul C Neary, Mihail Gabriel Dimofte, Sorinel Lunca, Diego Raimondo, Renato Seracchioli and Paolo Casadio critically reviewed the final manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Stefan Morarasu.

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O’Brien, L., Morarasu, S., Morarasu, B.C. et al. Conservative surgery versus colorectal resection for endometriosis with rectal involvement: a systematic review and meta-analysis of surgical and long-term outcomes. Int J Colorectal Dis 38, 55 (2023). https://doi.org/10.1007/s00384-023-04352-6

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