Comparison between the stripping technique and the combined excisional/ablative technique for the treatment of bilateral XXXX : a multicentre RCT.

@entity43 @entity1 @entity162 @entity2371 @entity3158 @entity46
STUDY QUESTION: Is the combined excisional/ablative technique for the treatment of @entity43 better than the traditional stripping technique in terms of recurrence rate? SUMMARY ANSWER: There is no evidence that the combined excisional/ablative technique is better than the traditional stripping technique, as similar recurrence rates were observed for the two techniques. WHAT IS KNOWN ALREADY: The stripping technique is associated with better results compared with ablative, non-excisional techniques for the treatment of @entity43 . Excisional techniques, such as stripping, have, however, been associated with reduced ovarian reserve as evaluated with anti-Mullerian hormone, and surgical techniques that better preserve the ovarian reserve are needed. STUDY DESIGN, SIZE, DURATION: A prospective, multicentre, randomized blinded clinical trial was carried out on 51 @entity1 with @entity46 larger than 3 cm. For each @entity1 , serving as her own control, one ovary was randomized to the stripping technique and the contralateral to the combined excisional/ablative technique. @entity1 were enrolled between January 2013 and April 2014. @entity1 /MATERIALS, SETTING, METHODS: @entity1 of reproductive age with @entity2371 affected by @entity46 larger than 3 cm were included (n = 51). The @entity1 underwent laparoscopic removal of @entity46 with two different surgical techniques performed at either side after random assignment: complete removal by stripping on one side versus the combined technique, consisting of partial excisional cystectomy followed by completion with ablative surgery using @entity162 , on the other side. Post-operative follow-up was performed at 1, 3 and 6 months after surgery for the evaluation of @entity46 recurrence (primary outcome) and of antral follicle count (AFC) and ovarian volumes (OVs) to assess ovarian reserve (secondary outcome). MAIN RESULTS AND THE ROLE OF CHANCE: Recurrence rates were 5.9% for the stripping technique versus 2.0% for the combined technique (odds ratio 3.00; 95% confidence interval: 0.24-157.5; P = 0.62). AFC in the ovaries treated with the stripping technique did not differ significantly from AFC in ovaries treated with the combined technique at all follow-up visits, whereas OV was significantly lower after the combined technique at the 6-month follow-up visit (P = 0.04). LIMITATIONS, REASONS FOR CAUTION: A major limitation of this study is the small sample size and particularly for ovarian reserve, the secondary outcome, for which no formal sample size calculation was performed. The lower-than-expected recurrence rates in the present series may be related to the shorter follow-up in our study compared with most studies in the literature. Further studies with larger sample sizes and longer follow-up are needed to confirm the findings of this study. The combined technique using @entity3158 laser energy instead of @entity162 should also be evaluated. WIDER IMPLICATIONS OF THE FINDINGS: The traditional excisional technique, i.e. the stripping technique, should still be considered the gold standard approach for the surgical treatment of @entity46 . STUDY FUNDING/COMPETING INTERESTS: No commercial funding was received. The authors report no relevant conflict of interest. TRIAL REGISTRATION NUMBER: ANZCTR number ACTRN12614000653662. TRIAL REGISTRATION DATE: 23 June 2014. DATE OF FIRST @entity1 'S ENROLMENT: 1 January 2013.
