Surgery for Endometriosis Improves Major Domains of Quality of Life: A Systematic Review and Meta-Analysis.
Author information
- 1
- Endometriosis Section, Gynecologic Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
- 2
- Endometriosis Section, Gynecologic Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR; Gynecologic Division, BP - A Beneficencia Portuguesa de Sao Paulo, Sao Paulo, SP, BR.
- 3
- Gynecologic Division, BP - A Beneficencia Portuguesa de Sao Paulo, Sao Paulo, SP, BR.
- 4
- Endometriosis Section, Gynecologic Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR; Gynecologic Division, BP - A Beneficencia Portuguesa de Sao Paulo, Sao Paulo, SP, BR. Electronic address: [email protected].
- 5
- Benign Gynecology Surgery Section, Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA.
Abstract
Because surgery for endometriosis can involve severe complications, it is important to determine if the patient's quality of life (QOL) is indeed improved after surgery. A systematic review and meta-analysis, when appropriate, were conducted and included 38 studies that assessed the QOL using validated questionnaires administered before and after surgery. Results were grouped according to the type of endometriosis reported: i) all types endometriosis; ii) deep infiltrative endometriosis (DIE); iii) bowel endometriosis. Quantitative analysis was performed on 17 homogeneous studies. Pooled response mean difference of 36-Item and 12-Item Short Form Survey (SF-36 and SF-12) showed significant improvement in Mental Component Score (MCS) after surgery for all types of endometriosis (0.21; CI:0.04-0.38); significant improvement after surgical treatment for DIE in Vitality (VT) (0.67; CI:0.41-0.94), Social Functioning (SF) (0.59; CI: 0.18-0.99), Role Emotional (RE) (0.49; CI:0.02-0.97), Mental Health (MH) (0.39; CI:0.03-0.74), Physical Functioning (PF) (0.93; CI:0.49-1.38), Bodily Pain (BP) (1.23; CI:0.47-1.99), General Health (GH) (0.57; CI:0.02-1.12), MCS (0.55; CI:0.10-1.00) and Physical Component Score (PCS) (0.73; CI:0.27-1.18); significant improvement after surgery for bowel endometriosis for all eight domains [VT (1.00; (CI:0.56-1.43); SF (0.97;CI:0.57-1.37); RE (1.17;CI:0.7-1.63); MH (0.94;CI:0.5-1.38); PF (0.74;CI:0.3-1.18); RP (1.25;CI:0.75-1.76); BP (1.39;CI:0.79-1.98; GH (0.84; CI:1.46-1.22)], MCS (0.93; CI:0.47-1.40), PCS (0.82; CI:0.40-1.23) and total score (1.15; CI:0.48-1.83). Only one study assessed patients with minimal disease and showed significant improvement in PCS (p=0.002) and MCS (p<0.001). This systematic review reveals that surgery for endometriosis resulted in overall improvement in the majority of health domains of HRQOL and the greatest improvement was found in BP domain.
KEYWORDS:
Bowel endometriosis; Deep infiltrative endometriosis; Endometriosis; Quality of life; Surgical treatment
- PMID:
- 30244153
- DOI:
- 10.1016/j.jmig.2018.09.774
Dr. K's Comment:
The evidence is solid - from 38 studies! So why are most gynecologists still avoiding surgery and are instead pushing medical suppression?