BJOG : an international journal of obstetrics and gynaecology · 2025
Effectiveness and Safety of Postoperative Medical Treatments Following Fertility-Preserving Surgery for Endometriosis: A Network Meta-Analysis.
СтатьяNetwork Meta-AnalysisНазвание и аннотация: Перевод в очереди
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Xiong Yi, Huang Wenrui, Wang Chenxin, Ma Wenjun, Jin Sufang, Lin Jin, Deng Xiaohua, Peng Yingfeng, Huang Yuchang, Du Xuelian, Han Xia
Аннотация
BACKGROUND: Endometriosis (EMs) is a common gynaecological condition with high recurrence rates after fertility-preserving laparoscopic surgery, and optimal postoperative medical treatment remains unclear.
OBJECTIVES: To evaluate the efficacy and safety of various postoperative medical treatments in reducing recurrence, pain and adverse events in EMs patients after fertility-preserving surgery.
SEARCH STRATEGY: PubMed, Web of Science, CENTRAL and Embase databases searched until August 1, 2024.
SELECTION CRITERIA: Randomised controlled trials (RCTs) involving women aged 20-45 years post-fertility-preserving laparoscopic surgery, comparing single postoperative medications with a minimum follow-up of 2 months.
DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data and assessed quality using ROB 2.0 and CINeMA. Bayesian network meta-analysis calculated odds ratios (OR) and mean differences (MD) for recurrence rates, VAS pain reduction and adverse events.
MAIN RESULTS: Sixteen RCTs (n = 1605 participants) evaluated 10 drugs: danazol, desogestrel, dienogest, gestrinone, goserelin, leuprolide, LNG-IUS, medroxyprogesterone, oral contraceptives and triptorelin. Only LNG-IUS significantly reduced recurrence rates (OR 0.12, 95% CI 0.02-0.63) and showed the greatest reduction in VAS pain scores (MD -24.96, 95% CI -41.76 to -8.75). Danazol significantly increased weight gain, and goserelin increased hot flashes.
CONCLUSIONS: LNG-IUS combined with laparoscopic surgery appears most effective in reducing recurrence and pain in EMs patients. Danazol and goserelin should be used cautiously due to notable adverse effects.
OBJECTIVES: To evaluate the efficacy and safety of various postoperative medical treatments in reducing recurrence, pain and adverse events in EMs patients after fertility-preserving surgery.
SEARCH STRATEGY: PubMed, Web of Science, CENTRAL and Embase databases searched until August 1, 2024.
SELECTION CRITERIA: Randomised controlled trials (RCTs) involving women aged 20-45 years post-fertility-preserving laparoscopic surgery, comparing single postoperative medications with a minimum follow-up of 2 months.
DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data and assessed quality using ROB 2.0 and CINeMA. Bayesian network meta-analysis calculated odds ratios (OR) and mean differences (MD) for recurrence rates, VAS pain reduction and adverse events.
MAIN RESULTS: Sixteen RCTs (n = 1605 participants) evaluated 10 drugs: danazol, desogestrel, dienogest, gestrinone, goserelin, leuprolide, LNG-IUS, medroxyprogesterone, oral contraceptives and triptorelin. Only LNG-IUS significantly reduced recurrence rates (OR 0.12, 95% CI 0.02-0.63) and showed the greatest reduction in VAS pain scores (MD -24.96, 95% CI -41.76 to -8.75). Danazol significantly increased weight gain, and goserelin increased hot flashes.
CONCLUSIONS: LNG-IUS combined with laparoscopic surgery appears most effective in reducing recurrence and pain in EMs patients. Danazol and goserelin should be used cautiously due to notable adverse effects.