Ablation and risk of recurrence in endometrioma: a systematic review and meta-analysis

ABSTRACT

Objective. Ovarian endometriosis, or endometriomas, is a common manifestation and is typically treated via laparoscopic cystectomy. However, this method may compromise ovarian function. Ablation, involving thermal destruction of endometriosis cells, is emerging as an alternative. Despite some evidence suggesting less impact on ovarian function, there is a lack of robust data on the efficacy of ablation in preventing recurrence. This systematic review and meta-analysis aim to evaluate the recurrence rates of ablation compared to standard cystectomy for ovarian endometriomas.
Materials and Methods. This study followed PRISMA guidelines and was registered with PROSPERO (protocol number CRD549177). Comprehensive searches were conducted in PubMed, EMBASE, Scopus, Google Scholar, ClinicalTrials.gov, and the Cochrane Central Register up to May 2024. Inclusion criteria focused on studies involving patients with at least one ovarian endometrioma treated with ablation or cystectomy, reporting recurrence rates, and having a minimum follow-up of 12 months. The studies were assessed for quality using the Newcastle-Ottawa Scale. Data were analyzed using fixed-effect or random-effect models based on heterogeneity, with statistical significance set at p < 0.05.
Results. The search identified 58 articles, with 16 meeting the criteria for review. 5 studies, encompassing 395 patients, were included in the final analysis. 4 studies compared ablation and cystectomy. Recurrence rates varied, with ablation ranging from 0% to 37.7% and cystectomy from 0% to 22%. Meta-analysis revealed a non-significant trend toward higher recurrence rates with cystectomy (OR 1.99, 95% CI 0.95-4.16, p=0.07). The heterogeneity was low (I2=0%, p=0.45).
Conclusions. This systematic review and meta-analysis did not find a statistically significant difference in recurrence rates between ablation and cystectomy for treating ovarian endometriomas. However, there was a non-significant trend favoring ablation. Further randomized controlled trials are necessary to confirm these findings and to better understand the long-term efficacy and safety of ablation compared to cystectomy.