Pashkunova Daria, Darici Kurt Ezgi, Hudelist Theresa, Rath Anna, Bokor Attila, Hudelist Gernot
Department of Gynecology, Center for Endometriosis, Hospital St. John of God, Vienna, Austria.
Department of Obstetrics &Gynecology, Floridsdorf Hospital, Vienna, Austria.
Acta Obstet Gynecol Scand. 2025 Aug;104(8):1550-1557. doi: 10.1111/aogs.15142. Epub 2025 May 1.
Patients undergoing colorectal surgery for symptomatic deep endometriosis may experience postoperative impairment of gastrointestinal function. However, there is limited information on long-term follow-up of this surgical sequela. We aimed to analyze 5-year postsurgical outcomes of gastrointestinal function in these patients, reflected by lower anterior resection syndrome (LARS) scores and gastrointestinal quality of life index (GIQLI).
This prospective study included patients who either underwent nerve-vessel-sparing segmental resection (NVSSR) or full-thickness discoid resection (FTDR) for symptomatic colorectal deep endometriosis from April 2017 to May 2022 at two tertiary referral centers. As published previously, gastrointestinal function was evaluated by LARS and GIQLI scores pre- and postsurgically (postoperative visit 1) and was now re-evaluated (postoperative visit 2) to gain information on long-term outcomes.
Out of 121 patients, 92 were eligible for the final analysis at postoperative visit 2. The mean follow-up interval was 58.5 ± 17.9 months in the NVSSR group and 61.6 ± 10.7 months in the FTDR group. As published previously, presurgical LARS-like symptoms were observed in 42/92 (45.7%) of patients, including 37/76 (48.7%) in the NVSSR group and 5/16 (31.3%) in the FTDR group. Compared to preoperative LARS scores, patients in the NVSSR group showed a significant reduction of LARS scores at long-term postoperative visit 2 (p = <0.001), with LARS scores remaining stable over postoperative visit 1 and visit 2 (p = 0.09) at 5 years postoperatively. In women following FTDR, presurgical and long-term postoperative visit 2 LARS scores remained statistically unchanged (p < 0.73), with worsening of LARS scores between postoperative visit 1 and visit 2 (p = 0.02). In contrast, significant improvement of GIQLI was observed between the preoperative visit and postoperative visit 2 at 5 years follow-up in both NVSSR and FTDR groups (p ≤ 0.001 and p = 0.001, respectively).
Compared to presurgical values, long-term gastrointestinal function reflected by LARS scores remains improved following NVSSR, whereas it remains unchanged following FTDR. However, when GIQLI is applied as patient-reported outcome measurement (PROM), patients show permanent, long-term improvement of gastrointestinal function following either NVSSR or FTDR for symptomatic colorectal endometriosis.
因症状性深部子宫内膜异位症接受结直肠手术的患者术后可能出现胃肠功能受损。然而，关于这种手术后遗症的长期随访信息有限。我们旨在分析这些患者术后5年的胃肠功能结局，以低位前切除综合征（LARS）评分和胃肠生活质量指数（GIQLI）为指标。
这项前瞻性研究纳入了2017年4月至2022年5月期间在两家三级转诊中心因症状性结直肠深部子宫内膜异位症接受保留神经血管节段切除术（NVSSR）或全层盘状切除术（FTDR）的患者。如之前发表的研究，术前和术后（术后首次随访）通过LARS和GIQLI评分评估胃肠功能，现在进行再次评估（术后第二次随访）以获取长期结局信息。
121例患者中，92例在术后第二次随访时符合最终分析条件。NVSSR组的平均随访间隔为58.5±17.9个月，FTDR组为61.6±10.7个月。如之前发表的研究，92例患者中有42例（45.7%）术前出现类似LARS的症状，其中NVSSR组76例中有37例（48.7%），FTDR组16例中有5例（31.3%）。与术前LARS评分相比，NVSSR组患者在术后长期第二次随访时LARS评分显著降低（p＜0.001），术后5年时，LARS评分在术后首次随访和第二次随访期间保持稳定（p = 0.09）。在接受FTDR的女性中，术前和术后长期第二次随访时的LARS评分在统计学上无变化（p＜0.73），术后首次随访和第二次随访之间LARS评分恶化（p = 0.02）。相比之下，在5年随访时，NVSSR组和FTDR组术前随访与术后第二次随访之间的GIQLI均有显著改善（分别为p≤0.001和p = 0.001）。
与术前值相比，NVSSR术后LARS评分所反映的长期胃肠功能持续改善，而FTDR术后则保持不变。然而，当将GIQLI作为患者报告结局指标（PROM）时，因症状性结直肠子宫内膜异位症接受NVSSR或FTDR治疗的患者胃肠功能均出现永久性的长期改善。
