The Long-term Impact of Post-Operative Oral Contraceptive Recommendations After Laparoscopic Cystectomy of Endometrioma on the Incidence of Endometrioma Recurrence and Ovarian Cancer Development

Abstract Background Previous studies have shown the ovarian carcinoma after laparscopic cystectomy of endometrioma arises through the recurrence of endometrioma. Then it can be assumed that reduction of ovarian endometrioma recurrence through postoperative medication can lead prevention of carcinogenesis. Therefore, this study aimed to evaluate the long-term impact of oral contraceptive (OC) recommendation after laparoscopic cystectomy of endometrioma on the incidence of endometrioma recurrence and ovarian cancer development.Methods This retrospective study included 546 patients who underwent laparoscopic cystectomy of ovarian endometrioma at a tertiary referral hospital to evaluate the OC recommendation following laparoscopic cystectomy of endometrioma introduced after the year 2005.Results This study included 218 patients in the pre-recommendation group and 328 patients in the post-recommendation group. Patient characteristics (age, gravida, parity at surgery, comorbidity of uterine fibroids and adenomyosis, revised American Society for Reproductive Medicine score, cyst size, and bilateral involvement) were comparable between the groups. Postoperative OC was recommended to be started and continued for at least 2 years in 3.2% of patients in the pre-recommendation group and 38.7% of patients in the post-recommendation group. The endometrioma recurrence rate was significantly lower in the post-recommendation group (3.8% per year) than in the pre-recommendation group (6.8% per year, p < .001). The incidence of ovarian cancer was lower in the post-recommendation group (0.063% per year) than in the pre-recommendation group (0.248% per year), although this difference was not significant. None of the patients who had used OC for > 2 years developed ovarian cancer.Conclusions Introduction of the postoperative OC recommendation after laparoscopy significantly reduced the recurrence rate of endometrioma, and tended to reduce the incidence of ovarian cancer.