Bowel Occult Microscopic Endometriosis In Resection Margins In Deep Colorectal Endometriosis Specimens Has No Impact On The Long-Term Risk Of Recurrence.

The variables influencing the risk of recurrence after segmental resection for rectosigmoid endometriosis are mostly unknown. This study aimed to assess if the risk of recurrence is influenced by the presence of bowel occult microscopic endometriosis (BOME) implants in colorectal resection specimen margins. Prospective study. This study included patients who underwent segmental resection for rectosigmoid endometriosis and had a follow-up of at least 5 years. Every year the patients underwent an assessment of pain (measured on a 10 cm VAS scale), intestinal symptoms (measured on a 10-point Likert scale), gastrointestinal function (measured using the Gastrointestinal Quality of Life Index, GIQLI), and quality of life (assessed using the Endometriosis Health Profile-30, EHP-30). Also, the patients underwent transvaginal ultrasonography to evaluate the presence of deep endometriosis recurrence. Magnetic resonance enema was performed in symptomatic patients with ultrasonographic suspicion of deep endometriosis recurrence. Outcomes were compared between patients with and without BOME implants in colorectal resection specimen margins. 72 patients were included in the study. 13 patients had BOME implants in colorectal resection specimen margins. Therefore, BOME was found in 18.1% of patients (in one margin in 8 patients and in both margins in 5 patients). Patients with and without BOME implants were similar in demographic and surgical characteristics (length of the rectosigmoid specimen removed, size of the largest intestinal endometriotic nodule, depth of infiltration of endometriosis in the intestinal wall, distance between the lower margin of the lesion and the anal verge, associated deep endometriotic lesions). The median length of follow-up was 9 years (range, 5-14 years); there was no significant difference in the length of follow-up between patients with and without BOME (p=0.282). 67 patients (93.1%) of the patients used some type of hormonal therapies during follow-up. 34 patients (47.2%) conceived during follow-up. No significant difference was observed in pain symptoms, intestinal symptoms, gastrointestinal function, and quality of life between patients with and without BOME. At five-year follow-up, imaging diagnosis of rectosigmoid endometriosis recurrence was observed in 5 patients without BOME implants (8.5%; 95% CI, 2.8%-18.7%) and 2 patients with BOME implants (15.4%; 95% CI, 1.9-45.4%; p=0.580). In 6 out of 7 patients, the diagnosis of rectosigmoid endometriosis recurrence was confirmed by surgery and histology. This study suggests that BOME implants do not affect the long-term risk of rectosigmoid endometriosis recurrence. Also, BOME implants do not influence postoperative symptoms. The major limitation of the study is the small sample size. The primary strength of the study is the long-term follow-up.