Tailoring radicality in diaphragmatic surgery for deep endometriosis: A matter of choice

IF 3.9 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Best Practice & Research Clinical Obstetrics & Gynaecology Pub Date : 2024-07-01 DOI:10.1016/j.bpobgyn.2024.102499
Marcello Ceccaroni , Gianmarco D'Ancona , Giovanni Roviglione , Sarah Choi , Tommaso Capezzuoli , Andrea Puppo , Ashot Drampyan , Fabio Barra
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Abstract

Diaphragmatic endometriosis (DpE) is a rare disease localization which represents an important clinical challenge. The main criticisms toward the proper DpE management consist of poor consensus on both surgical indications and the choice between different surgical techniques available to treat the disease. Furthermore, only weak recommendations are provided by current guidelines and surgical management is mostly based on surgeon's experience. As consequence, the lack of standardization about the surgical treatment led to the risk of under- or over-treatments in patients suffering from this form of endometriosis.

The latest evidence-based data suggest to adopt a lesion-oriented surgical approach serving as a guide in daily surgical activities, in order to ensure a tailored radicality and reduce the rate of surgery-related complications.

Diaphragmatic endometriosis surgery should be performed only by expert surgeons with an extensive oncogynecologic expertise since it represents a technically demanding procedure. A multidisciplinary approach is also mandatory in order to adequately select and treat these patients by minimizing the risk of additional morbidity.

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为深部子宫内膜异位症的膈肌手术量身定制根治方案:选择问题。
横膈膜子宫内膜异位症(DpE)是一种罕见的疾病定位,是一项重要的临床挑战。对横膈膜子宫内膜异位症正确治疗的主要批评意见包括:对手术适应症和不同手术技术之间的选择缺乏共识。此外,目前的指南仅提供了一些薄弱的建议,手术治疗大多基于外科医生的经验。因此,由于手术治疗缺乏标准化,这种子宫内膜异位症患者可能会面临治疗不足或治疗过度的风险。最新的循证医学数据表明,以病灶为导向的手术方法可作为日常手术活动的指南,从而确保手术的根治性,降低手术相关并发症的发生率。膈肌子宫内膜异位症手术只能由具有丰富妇科肿瘤专业知识的外科医生进行,因为这是一项技术要求很高的手术。此外,还必须采用多学科方法,以充分选择和治疗这些患者,最大限度地降低额外发病率的风险。
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来源期刊
CiteScore
9.40
自引率
1.80%
发文量
113
审稿时长
54 days
期刊介绍: In practical paperback format, each 200 page topic-based issue of Best Practice & Research Clinical Obstetrics & Gynaecology will provide a comprehensive review of current clinical practice and thinking within the specialties of obstetrics and gynaecology. All chapters take the form of practical, evidence-based reviews that seek to address key clinical issues of diagnosis, treatment and patient management. Each issue follows a problem-orientated approach that focuses on the key questions to be addressed, clearly defining what is known and not known. Management will be described in practical terms so that it can be applied to the individual patient.
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