Document Detail


Surgical treatment of endometriosis-associated infertility: meta-analysis compared with survival analysis.
MedLine Citation:
PMID:  7802058     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Our purpose was to evaluate the role of surgery in the treatment of endometriosis associated with infertility. STUDY DESIGN: We used a prospective cohort analysis of pregnancy rates and variables affecting pregnancy rates for surgical, medical, and no treatment. Our studies were combined with those reported by Hughes et al. (Fertil Steril 1993; 59:963-70), and the meta-analysis was expanded to include additional comparisons. Treatment was performed by a single surgeon in a referral reproductive endocrinology and surgery private practice. Results from 579 women with endometriosis and infertility in our study and the meta-analysis of 25 studies by Hughes et al. were examined. Interventions consisted of no treatment, medical treatment, or surgical treatment by laparoscopy or laparotomy. The main outcome measure was pregnancy rates. RESULTS: For minimal and mild disease, no treatment, laparoscopy, and laparotomy had equivalent 3-year estimated cumulative life-table pregnancy rates (67% +/- 12%, 68% +/- 4%, and 74% +/- 8%, respectively) that were higher than medical treatment pregnancy rates (Breslow p = 0.003). For moderate and severe disease, all but 11 patients were treated surgically. The 3-year estimated cumulative life-table pregnancy rates were 62% + 6% [corrected] for 120 laparoscopy cases and 44% + 6% [corrected] for 102 laparotomy cases (Breslow p = 0.054). For endometriomas, 48 laparoscopy patients had a 3-year estimated cumulative life-table pregnancy rate of 52% +/- 9% and 52 laparotomy patients had a 3-year estimated cumulative life-table pregnancy rate of 46% +/- 9% (Breslow p = 0.48). For 28 patients with complete cul-de-sac obliteration, the 3-year estimated cumulative life-table pregnancy rates were 30% +/- 14% after laparoscopy and 24% +/- 12% after laparotomy (Breslow p = 0.084). Comparison of our results with the expanded meta-analysis revealed deficiencies in the design of meta-analysis studies and the impact of our using life-table pregnancy rates controlled for factors influencing outcome (survival analysis with fixed covariates) rather than the simple pregnancy rates used in the meta-analysis. Benefits of sophisticated statistical techniques, including propensity scores, to adjust for noncomparability of groups in prospective cohort studies were identified. CONCLUSION: Both our study and the meta-analysis show that either no treatment or surgery is superior to medical treatment for minimal and mild endometriosis associated with infertility. For moderate and severe disease, surgery is usually used. In these patients experienced surgeons utilizing good clinical judgment can achieve results at operative laparoscopy at least equivalent to those at laparotomy, even in cases involving endometriomas and complete cul-de-sac obliteration. Prospective randomized trials should be performed to confirm these findings.
Authors:
G D Adamson; D J Pasta
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Publication Detail:
Type:  Comparative Study; Journal Article; Meta-Analysis    
Journal Detail:
Title:  American journal of obstetrics and gynecology     Volume:  171     ISSN:  0002-9378     ISO Abbreviation:  Am. J. Obstet. Gynecol.     Publication Date:  1994 Dec 
Date Detail:
Created Date:  1995-01-23     Completed Date:  1995-01-23     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0370476     Medline TA:  Am J Obstet Gynecol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1488-504; discussion 1504-5     Citation Subset:  AIM; IM    
Affiliation:
Department of Gynecology and Obstetrics, Stanford University School of Medicine, Palo Alto, CA.
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MeSH Terms
Descriptor/Qualifier:
Cohort Studies
Endometriosis / complications*
Female
Humans
Infertility, Female / etiology*,  surgery*,  therapy
Laparoscopy
Laparotomy
Pregnancy
Prospective Studies
Survival Analysis
Comments/Corrections
Erratum In:
Am J Obstet Gynecol 1995 Jun;172(6):1937

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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