Roundtable Discussion
29 June 1998
Geff Klein, MD
gklein@icsi.net
Interesting article. I would argue the need for further research before proclaiming this an effective therapy. The pathophysiology does not seem to make this a biologically plausible approach.
Rodolphe Maheux, MD
RMaheux@compuserve.com
This is an interesting article on conservative management of post-operative peritoneal cysts associated with endometriosis. Fine-needle cytology and drainage has been performed in the 6 patients and 4 also received post-op GnRHa for 6 months. Those who received post-op GnRHa are said to be AFD (alive, free of disease) whereas the 2 who did not received GnRHa are AWS (alive, with disease)
I would be interested to have more information on the symptomatology of these women and the effect of the proposed treatment on their symptomatology. When a pathology is non cancerous or pre-cancerous, therapeutic approaches should be oriented toward the symptoms of the patient. My first critique here is that I did not find in this article enough evidence to demonstrate that initially the symptoms were severe enough to justify the proposed treatment. Secondly, I would be very interested to understand if the expression AFD after treatment only means that no cyst recurs or does-it mean that those women were cured of their chronic pelvic pain or urinary symptoms. From a patient point of view, it is the disappearance of the symptoms that really count. When a woman develops post-op peritoneal cyst, she often presents also adhesions and the symptoms may be related to the cyst and/or to the adhesions.
It is therefore very important to evaluate the success of this approach in terms of its success to cure the symptoms of the patient. Were the symptoms objectively evaluated before treatment by a valid pain questionnaire, were-they severe enough to justify treatment and did the authors recheck objectively after the surgery the effect of their approach on those symptoms. I will personally very often just observe a patient developing a post-op cyst if the patient is ± asymptomatic, the cyst is thin-walled containing no papillations or solid areas and serum levels of CA125, CEA and CA 19-9 are in the normal range.
Robert Radnich, MD
rradnich@dca.net
I was glad to know of this therapy, as it seems their results were quite good. I am not sure I have seen this in over 20 years of practice, however. I'm not sure of the etiology or incidence.
30 June 1998
Mark Perloe, M.D.
mperloe@ivf.com
I am curious to know whether the peritoneal cysts were symptomatic. And, if not, why would such a procecdure be undertaken. While the benefits in this small population seem to be documented well, the study does not provide any evidence to suggest that is the case. As many patients with endometriosis will experience a postoperative recurrence following incomplete surgical treatment and GnRH-a treatment, I wonder why the duration of GnRH-a treatment in this case should be so long lasting.