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Long-term evaluation of quality of life and gastrointestinal well-being after segmental colo-rectal resection for deep infiltrating endometriosis (ENDO-RESECT QoL)

  • General Gynecology
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Abstract

Purposes

The primary objective is to assess the long-term quality of life (QoL) and gastrointestinal well-being in patients with endometriosis (DIE) who underwent segmental resection (SR), through specific questionnaires focused on endometriosis and specific gastrointestinal evaluation. The secondary objectives are represented by the evaluation of peri-operative and post-operative outcomes of the procedure.

Methods

This observational cohort study ENDO-RESECT (ClinicalTrials.gov ID: NCT03824054) reports all clinical data about women who underwent SR for DIE between October 2005 and November 2017. In the part of the study dedicated to the QoL assessment, the questionnaires adopted were the Endometriosis Health Profile (EHP30), the Psychological General Well-Being Index and the Hospital Anxiety and Depression Scale, the Gastrointestinal Well-being questionnaire and the Bristol Stool chart. Major post-surgical morbidity and obstetric outcomes were also collected.

Results

50 women (18% stage III and 82% stage IV rAFS) were considered for enrollment. EHP-30 interpretation demonstrated a significant improvement in all continuous variables, except for fertility concerns. The overall gastrointestinal QoL and most of the specific symptoms improved after surgery. Frequent bowel movements appeared in the 13% of the series not resulting in an impairment of general and gastrointestinal QoL. Constipation remained unchanged. Patients with depressive mood managed with laparoscopy, benefited the most from SR; moreover, patients with multinodular bowel localizations experienced a greater reduction in abdominal pain. Median FU after SR was 42.5 months (range 12–157 months). Only three (6%) cases of late major grade III complications were documented. The pregnancy rate was 50%.

Conclusions

Improvement of general QoL and most of gastrointestinal symptoms was documented after SR.

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Acknowledgements

The authors thank Dr. Franziska Michaela Lohmeyer (Fondazione Policlinico Universitario A. Gemelli IRCCS-Direzione Scientifica IRCCS) and Dr Richard Renston M.D. for their important contribution in revising the form and the English language of this article.

Funding

This study did not receive any fund.

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Authors and Affiliations

  1. Division of Gynecologic Oncology, Fondazione di Ricerca e Cura Giovanni Paolo II, Università Cattolica del Sacro Cuore, Campobasso, Italy

    Luigi Carlo Turco & Francesco Cosentino

  2. Medicina Interna e Gastroenterologia, Area Gastroenterologia ed Oncologia Medica, Dipartimento di Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-Urologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

    Franco Scaldaferri

  3. Division of Gynecologic Oncology, Università di Palermo, Palermo, Italy

    Vito Chiantera

  4. Department of Women’s and Children’s Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

    Stefano Cianci, Anna Fagotti, Francesco Fanfani, Gabriella Ferrandina, Virginia Vargiu & Giovanni Scambia

  5. Department of Human Pathology of the Adult and of the Childhood “Gaetano Barresi”, Università di Messina, Messina, Italy

    Alfredo Ercoli

  6. Università Cattolica del Sacro Cuore, Rome, Italy

    Anna Fagotti, Francesco Fanfani, Gabriella Ferrandina & Giovanni Scambia

  7. Medical Management, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

    Nicola Nicolotti & Andrea Tamburrano

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  1. Luigi Carlo Turco
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Correspondence to Luigi Carlo Turco.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (No. PROT. APROV. IST CICOG-31-10-18\100) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Supplementary figure 1

Mean GSRS score for specific symptoms (reflux, diarrhea syndrome, constipation syndrome, abdominal pain, indigestion syndrome) in relation to single vs multiple nodules at referred pre-surgical status and at last FU after surgery. p value calculated by t-test for 2 means. a Single nodule and b multiple nodules (TIFF 82 kb)

Supplementary figure 2

Mean GSRS score for specific symptoms (reflux, diarrhea syndrome, constipation syndrome, abdominal pain, indigestion syndrome) in relation to the state of anxiety at referred pre-surgical status and at last FU after surgery. p value calculated by t-test for 2 means. a Non anxious patients and b anxious patients (TIFF 81 kb)

Supplementary figure 3

Mean GSRS score for specific symptoms (reflux, diarrhea syndrome, constipation syndrome, abdominal pain, indigestion syndrome) in relation to the state of depression at referred pre-surgical status and at last FU after surgery. p value calculated by t-test for 2 means. a Non depressed patients and b depressed patients (TIFF 81 kb)

Supplementary figure 4

Mean GSRS score for specific symptoms (reflux, diarrhea syndrome, constipation syndrome, abdominal pain, indigestion syndrome) in patients underwent different surgical approach at referred pre-surgical status and at last FU after surgery. p value calculated by t-test for 2 means. a Laparoscopy and b laparotomy (TIFF 81 kb)

Supplementary material 5 (DOCX 16 kb)

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Turco, L.C., Scaldaferri, F., Chiantera, V. et al. Long-term evaluation of quality of life and gastrointestinal well-being after segmental colo-rectal resection for deep infiltrating endometriosis (ENDO-RESECT QoL). Arch Gynecol Obstet 301, 217–228 (2020). https://doi.org/10.1007/s00404-019-05382-8

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