Treatment of thoracic endometriosis syndrome: A meta-analysis and review
Open accessAbstract
Background Thoracic endometriosis syndrome (TES) is a rare disorder characterized by the presence of functional endometrial tissue within the chest cavity. Up to 80% of women with TES present with concomitant pelvic endometriosis. The diagnostic-curative path is defined by both thoracic surgeons and gynecologists, consistent with the manifestation of the disease. The aim of the study was to analyze the different approaches to generate an ideal diagnosis-treatment algorithm that can be shared by both specialties.Methods We searched PubMed and Scopus for studies that were completed by March 2019 and that included at least 8 patients with TES. Information on preoperative exams, surgical technique, postoperative management, and recurrence of disease was collected for meta-analysis.Results Twenty-five studies including a total of 732 patients were eligible. Almost all of the patients underwent radiologic pelvis investigation (96%; confidence interval [CI], 87%-100%). Videothoracoscopy was the preferred surgical technique (84%; 95% CI, 66%-96%). Intraoperative evaluation revealed the presence of diaphragmatic anomalies in 84% of cases (95% CI, 73%-93%). The overall pooled prevalence of concomitant or staged laparoscopy was 52% (95% CI, 18%-85%). Postoperative hormone therapy was heterogeneous with a pooled prevalence of 61% (95% CI, 33%-86%; I 2 = 95.6%; P < .01). Recurrence of symptoms was documented in 27% of patients (95% CI, 20%-34%; I 2 = 54.7%; P < .01).Conclusions TES should be managed jointly by thoracic surgeons and gynecologists. Chest-abdomen magnetic resonance imaging seems to offer the most details for TES. Combined or staged videothoracoscopy and laparoscopy can provide adequate information to fine-tune proper surgical treatment and postoperative medical therapy.
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A chest and abdomen MRI is considered the most appropriate pre-operative imaging study for thoracic endometriosis syndrome at this time.
“A chest and abdomen MRI is considered the most appropriate pre-operative imaging study at this time [ 17 ].”
From Thoracic Endometriosis Syndrome: A Comprehensive Review and Multidisciplinary Approach to Management (2024) · cites this paper as [17]
Even after bilateral salpingo-oophorectomy, dormant endometrial implants may activate with exogenous estrogen administration.
“Even after bilateral salpingo-oophorectomy, dormant endometrial implants may activate with exogenous estrogen administration [ 17 , 82 ].”
From Thoracic Endometriosis Syndrome: A Comprehensive Review and Multidisciplinary Approach to Management (2024) · cites this paper as [17]
Ciriaco et al. showed that estrogen-progesterone pills alone were not an effective post-surgical treatment regimen, with a 100% catamenial pneumothorax recurrence rate.
“Of note, Ciriaco et al. showed that estrogen–progesterone pills alone were not an effective post-surgical treatment regimen, as the cohort placed on this treatment had a 100% catamenial pneumothorax recurrence rate [ 17 ].”
From Thoracic Endometriosis Syndrome: A Comprehensive Review and Multidisciplinary Approach to Management (2024) · cites this paper as [17]
The presence of severe pelvic endometriosis is often noted in thoracic endometriosis syndrome.
“The presence of severe pelvic endometriosis is often noted [ 17 , 23 , 45 , 68 , 70 ].”
From Thoracic Endometriosis Syndrome: A Comprehensive Review and Multidisciplinary Approach to Management (2024) · cites this paper as [17]
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- Authors
- Ciriaco, P., Muriana, P., Lembo, R., Carretta, A., & Negri, G.
- Affiliations
- Vita-Salute San Raffaele University (IT)
- Corresponding author
- Ciriaco, Paola
- Venue
- The Annals of Thoracic Surgery
- Publisher
- Elsevier BV
- Published
- 2022-01
- Volume
- 113
- Issue
- 1
- Pages
- 324-336
- ISSN
- 0003-4975 (ISSN-L)
- OpenAlex
- W3112975684
- Cited by
- 47
- References
- 47
- Citations by year
- 2026: 10 · 2025: 8 · 2024: 10 · 2023: 7 · 2022: 9 · 2021: 3
- FWCI
- 0.70
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Locations
- The Annals of Thoracic Surgery (publishedVersion)
- PubMed (publishedVersion)
- Archivio Istituzionale della Ricerca - Università Vita-Salute San Raffaele (submittedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Pleural and Pulmonary Diseases
- Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
- Keywords
- thoracic endometriosis syndrome, videothoracoscopy, diaphragmatic anomalies, pelvic endometriosis, postoperative hormone therapy, recurrence, surgical algorithm, multidisciplinary management
- MeSH terms
- Algorithms, Endometriosis, Female, Humans, Syndrome, Thorax
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