Digestive-functional-outcomes-following-conservative-or

Digestive functional outcomes following conservative or radical surgery in
large deep endometriosis infiltrating the rectum: ENDORE randomized trial
Abstract ID : 1516
Soumis par : Roman Horace Le 2016-02-23 17:08:18
Nom de la catégorie : SEUD CONGRESS
Typologie : Communication orale / Oral communication
Statut : validé
Autorisation de diffusion : Yes/Oui
------------------------------------Objective: To compare postoperative digestive outcomes following respectively conservative and radical surgery in large
deep endometriosis infiltrating the rectum (ENDORE, NCT 01291576).
Methods: Prospective, in intention to treat, randomized trial, enrolling patients with deep endometriosis infiltrating the
rectum up to 15 cm from the anus, for whom rectal involvement exceeds 20 mm on length, the muscular layer on depth,
and up to 50% on rectal circumference. Patients underwent conservative (shaving or disc excision) or radical rectal
surgery (colorectal resection) in three tertiary referral centers. Main outcome focused on postoperative digestive function
assessed 24 months postoperatively using the Knowles-Eccersley-Scott-Symptom Questionnaire (KESS), the
Gastrointestinal Quality of Life Index (GIQLI), the Wexner scale and the Bristol Stool Chart.
Results: 60 patients were enrolled during 30 months. In the arm of the conservative surgery, shaving was performed in
10 patients (37%), disc excision in 15 (55.6%) while 2 patients underwent conversion to colorectal resection (7.4%). In
the arm of radical surgery, 33 patients had colorectal resection. In women with disc excision, largest disc diameter was
47 +/- 14mm (range 20; 70). In the arm of radical surgery, the length of colorectal specimen was 97 +/- 48mm (range 20;
200mm).
Two rectovaginal fistulae occurred in 2 patients in the arm of conservative surgery (7.4%), however one of them actually
underwent colorectal resection. Four patients (12.1%) presented a stenosis at the level of colorectal anastomosis in the
arm of radical surgery, requiring complementary procedures (P=0.06). Postoperative severe rectorrhage from the
stapled line occurred in 3 patients (9.1%) in the arm of radical surgery (P=0.11).
In intention to treat and per protocol comparisons of overall values of KESS, GIQLI, Wexner and Bristol scores did not
reveal significant differences between the two groups. Respectively 63% and 57% of patients estimated having normal
bowel movements 2 years after the surgery (P=0.66).
Two years after the surgery, women with pregnancy intention got pregnant in respectively 64.3% and 52.4%, while
66.7% and 72.7% of pregnancies were spontaneous.
Conclusions: Conservative surgery is feasible in more than 90% of patients managed for large rectal endometriosis. Two
years postoperatively, women managed by either conservative or radical surgery for large rectal endometriosis present
comparable digestive functional outcomes.
------------------------------------Mots clefs : colorectal endometriosis, deep endometriosis, shaving, disc excision, colorectal resection
Auteurs :
Références : , , ,
Auteurs
Horace Roman 1,
1. Gynecology, Rouen University Hospital, Rouen, FRANCE
Auteurs (raw format)
Roman Horace - email : [email protected] Etablissement : Rouen University Hospital Service : Gynecology
Ville : Rouen Pays : FRANCE Présentateur : Oui