AB032. SOH23ABS_019. Conservative surgery versus colorectal resection for endometrial deposits: a systematic review and meta-analysis of surgical and long-term outcomes

Background: The optimal surgical management of colorectal endometriosis is unclear. Conservative surgery by shaving or discoid excision of colorectal deposits facilitates organ preservation but is associated with an increased risk of recurrence. Formal colorectal resection is associated with higher rates of complications but may be associated with lower recurrence rates. This meta-analysis compares perioperative and long-term outcomes between conservative surgery (shaving or discoid excision) and formal colorectal resection.

Methods: A systematic search was performed to find comparative studies looking at outcomes in patients undergoing conservative surgery versus patients undergoing formal colorectal resection for rectal endometrial deposits. Data was extracted and analysed using a random effects model.

Results: Seventeen studies including 2,834 patients were analysed with patients subdivided by procedure: colorectal resection (n=1,389), shaving (n=703) and discoid excision (n=742). When formal colorectal resection was compared to conservative surgery there was a lower risk of recurrence (P=0.002), comparable functional outcomes [minor low anterior resection syndrome (LARS), P=0.30, major LARS, P=0.54], similar rates of postoperative leaks (P=0.22), pelvic abscesses (P=0.18) and rectovaginal fistula (P=0.92). On subgroup analysis, shaving had the highest recurrence rate (P=0.0007), however a lower rate of stoma formation (P<0.00001) and rectal stenosis (P=0.01). Discoid excision and formal resection were comparable.

Conclusions: Colorectal resection has a significantly lower recurrence rate compared to shaving. There is no difference in complications or functional outcomes between discoid excision and formal resection and both have similar recurrence rates.

Keywords: Discoid excision; endometriosis; rectal; resection; shaving