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Heat can treat: long-term follow-up results after uterine-sparing treatment of adenomyosis with radiofrequency thermal ablation in 60 hysterectomy candidate patients

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Abstract

Background

Adenomyosis may induce pelvic pain, abnormal uterine bleeding or bulk symptoms. If hormonal treatment proves ineffective or contraindicated, hysterectomy may be necessary. For patients who desire to conserve the uterus despite severe symptomatology, uterine-sparing techniques have been introduced. Radiofrequency thermal ablation (RFA) consists of the local application of high temperature to eliminate diseased tissue, applied recently for adenomyosis treatment.

The objective of the study was to analyze the efficacy of RFA for avoiding hysterectomy in patients with adenomyosis-related symptoms.

Methods

This is a single-center, retrospective cohort study performed in a referral center for endometriosis. The study population consisted of all consecutive patients who underwent Radiofrequency thermal ablation (RFA) treatment as an alternative to hysterectomy for adenomyosis between March 2011 and June 2019 in our institution. RFA was performed using laparoscopic access. To evaluate the impact of RFA treatment on symptoms, follow-up findings were compared to preoperative symptomatology using the ten-point visual analog scale (VAS) for pain assessment.

Results

Sixty patients were included in the study, 39 of them (65%), underwent a concomitant surgery for endometriosis in association to RFA. On a long-term follow-up (mean 56 months (range 10–115, SD 29), hysterectomy was performed in 8 patients (13%). The mean VAS score before vs after surgery was 7.4 vs 3.3 for dysmenorrhea, 3.7 vs 0.3 for dyschezia, 4.7 vs 0.7 for dyspareunia, and 4.0 vs 1.4 for chronic pelvic pain, being significantly reduced after RFA for all these pain components (p < 0.0001 in every case). Thirty-one patients (52%) suffered from AUB before RFA, this symptom persisted in 10 patients (16%) during follow-up (p < 0.001). Bulk symptoms were present in 16 patients (27%) and disappeared after RFA in all cases.

Conclusions

RFA allows for hysterectomy avoidance in most cases. It leads to marked improvements in pain symptomatology, uterine bleeding and bulk symptoms.

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Abbreviations

RFA :

Radiofrequency thermal ablation

MUSA :

Morphological Uterus Sonographic Assessment

HIFU :

High-intensity focused ultrasound

AUB :

Abnormal uterine bleeding

VAS :

Ten-point visual analog scale

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Acknowledgements

We thank Nicoletta De Santis for data managing, Elinor Julie Rae Anderson for language editing and Elvia Malo for methodological support.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore - Don Calabria, Via Don A. Sempreboni, 5, 37024, Negrar (Verona), Italy

    Anna Katarzyna Stepniewska, Silvia Baggio, Roberto Clarizia, Francesco Bruni, Giovanni Roviglione, Matteo Ceccarello, Maria Manzone & Marcello Ceccaroni

  2. Department of Cultures and Civilizations, University of Verona, Viale dell’Università 4, 3712, Verona, Italy

    Massimo Guerriero

  3. Clinical Research Unit, IRCCS Ospedale Sacro Cuore - Don Calabria, Via Don A. Sempreboni, 5, 37024, Negrar (Verona), Italy

    Massimo Guerriero

Authors
  1. Anna Katarzyna Stepniewska
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  2. Silvia Baggio
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  3. Roberto Clarizia
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  4. Francesco Bruni
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  5. Giovanni Roviglione
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  6. Matteo Ceccarello
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  7. Maria Manzone
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  8. Massimo Guerriero
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  9. Marcello Ceccaroni
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Corresponding author

Correspondence to Anna Katarzyna Stepniewska.

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Disclosures

Anna K. Stepniewska declares that she has no conflict of interest and nothing to disclose. Silvia Baggio declares that she has no conflict of interest and nothing to disclose. Roberto Clarizia declares that he has no conflict of interest and nothing to disclose. Francesco Bruni declares that he has no conflict of interest and nothing to disclose. Giovanni Roviglione declares that he has no conflict of interest and nothing to disclose. Matteo Ceccarello declares that he has no conflict of interest and nothing to disclose. Maria Manzone declares that she has no conflict of interest and nothing to disclose. Massimo Guerriero declares that he has no conflict of interest and nothing to disclose. Marcello Ceccaroni declares that he has no conflict of interest and nothing to disclose.

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Stepniewska, A.K., Baggio, S., Clarizia, R. et al. Heat can treat: long-term follow-up results after uterine-sparing treatment of adenomyosis with radiofrequency thermal ablation in 60 hysterectomy candidate patients. Surg Endosc 36, 5803–5811 (2022). https://doi.org/10.1007/s00464-021-08984-z

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