Postoperative hormonal treatment for prevention of endometrioma recurrence after ovarian cystectomy: a systematic review and network meta-analysis.
BACKGROUND
The efficacy of hormonal regimens for the prevention of endometrioma recurrence in women who have undergone conservative surgery is still controversial.


OBJECTIVE
To compare the efficacy of different hormonal regimens in this context and to rank them.


SEARCH STRATEGY
MEDLINE and Scopus databases were searched through January 2020.


SELECTION CRITERIA
Randomised controlled trials (RCTs) or cohorts, comparing the effect of any pair of interventions (i.e. cyclic oral contraceptives [OC], continuous OC, gonadotropin-releasing hormone agonist [GnRHa], dienogest [DNG], levonorgestrel-releasing intrauterine system [LNG-IUS] and expectant management) on endometrioma recurrence were selected.


DATA COLLECTION AND ANALYSIS
Data were independently extracted by two reviewers. Relative treatment effects were estimated using network meta-analysis (NMA) and ranked in descending order.


MAIN RESULTS
Six RCTs (675 patients) and 16 cohorts (3089 patients) were included. NMA of the RCTs involving expectant management, cyclic OC, continuous OC, GnRHa and GnRHa + LNG-IUS, showed that all hormonal regimens had a nonsignificant lower risk of endometrioma recurrence compared with expectant management. NMA of the cohorts involving expectant, cyclic OC, continuous OC, GnRHa, DNG, LNG-IUS, GnRHa + OC, and GnRHa + LNG-IUS indicated that LNG-IUS, DNG, continuous OC, GnRHa + OC and cyclic OC had a significantly lower risk of endometrioma recurrence than expectant management. LNG-IUS was ranked highest, followed by DNG and GnRHa + LNG-IUS. Long-term use of hormonal treatment either OC or progestin had a significantly lower risk of endometrioma recurrence than expectant treatment.


CONCLUSION
In the NMA of RCTs, there was no evidence supporting hormonal treatment for postoperative prevention of endometrioma recurrence. This was at odds with the cohort evidence, which found the protective effect of OC and progestin regimens, especially long-term treatment. Large-scale RCTs of these agents are still required.


TWEETABLE ABSTRACT
Hormonal regimens given as long-term treatment tend to reduce risk of endometrioma recurrence after conservative surgery.
['Wattanayingcharoenchai|R|R|0000-0002-1434-4627', 'Rattanasiri|S|S|0000-0001-7213-6116', 'Charakorn|C|C|', 'Attia|J|J|', 'Thakkinstian|A|A|']
D004715:Endometriosis D015914:Estrogen Replacement Therapy D005260:Female D006801:Humans D009364:Neoplasm Recurrence, Local D010049:Ovarian Diseases D010052:Ovariectomy D011183:Postoperative Complications D016032:Randomized Controlled Trials as Topic
hormonal treatment Endometrioma recurrence ovarian cystectomy network meta-analysis