Risk factors for recurrent endometriosis after conservative surgery in a quaternary care center in southern Thailand

Pongpan Ngernprom; Satit Klangsin; Chitkasaem Suwanrath; Krantarat Peeyananjarassri

doi:10.1371/journal.pone.0289832

Peer Review History

Original SubmissionOctober 25, 2022
11 Jul 2023 Decision Letter - Diego Raimondo, Editor PONE-D-22-29483Risk factors for recurrent endometriosis after conservative surgery in a quaternary care center in southern ThailandPLOS ONE Dear Dr. Klangsin, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Aug 25 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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(Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The manuscript by Ngernprom et al is an interesting report on 362 patients followed-up after surgery for endometriosis. The Authors identified the risk factors for recurrence, some of which were not identified in the previous literature. However, being the only novelty the identification of previously unreported risks factors for recurrence, one of which may be in fact a limitation of the study (in fact, 17% of oophorectomies in a population with a mean age of 34 may be considered an overtreatment, if details on surgery are not provided), I am not sure that the paper meets the high standards required for a high impact journal. Minor issues: Line 3 (short title): factors, not factor; surgery for endometriosis, not surgery in endometriosis. Line 31 (abstract): with the same or higher VAS; add "or higher". Line 58 (intro): glands, not gland. Line 69 (intro): add some reference on the general treatment of endometriomas, such as Chapron C et al "Management of ovarian endometriomas", Hum Reprod Update 2002, and Muzii L et al "Management of endometriomas", Semin Reprod Med 2017. Line 81 (intro): too many references to attest the high endometriosis load of the Authors (refs 17, 18, 19). Select only one of the three. Ref 20 is on the other hand appropriate in the text. Line 264 (discussion): close follow-up, not closed Reviewer #2: Dear author, thank you for the opportunity to analyze this interesting study on such a widespread pathology. However, I believe that some elements should be specified in the introduction: - endometriosis can be responsible for symptoms even in the menopausal age, varying between 2 and 5% of cases [you can cite: M M Ianieri et al. Retroperitoneal endometriosis in postmenopausal woman causing deep vein thrombosis: case report and review of the literature] - I suggest specifying that the recurrence rate of endometriosis also varies according to the definition of recurrence among the various authors In the discussion session: - advice to improve and enrich the discussion about the potential role of deep endometriosis on disease recurrence, particularly if radical surgery has not been performed. It would in fact be suggested to specify this aspect in the results or even in the tables. In particular, it would be interesting to know in your series the incidence of endometriosis of the parameters which can often be associated with ovarian endometriosis and whose non-treatment can be associated with persistence/recurrence of symptoms [Ianieri MM et al. Impact of nerve-sparing posterolateral parametrial excision for deep infiltrating endometriosis on postoperative bowel, urinary, and sexual function]. You cannot speak of ovarian recurrence without specifying the possible infiltration of the parameters which are anatomical structures adjacent to the ovaries ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". 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Revision 1
14 Jul 2023 Author Response Reviewer #1: The manuscript by Ngernprom et al is an interesting report on 362 patients followed-up after surgery for endometriosis. The Authors identified the risk factors for recurrence, some of which were not identified in the previous literature. However, being the only novelty the identification of previously unreported risks factors for recurrence, one of which may be in fact a limitation of the study (in fact, 17% of oophorectomies in a population with a mean age of 34 may be considered an overtreatment, if details on surgery are not provided), I am not sure that the paper meets the high standards required for a high impact journal. Response: We understood your mention of oophorectomy in conservative surgery. Additionally, I analyzed the data based on the oophorectomy group compared to the non-oophorectomy group, and discussion was more in the scope with which you are concerned. Previous manuscript: - Revised manuscript: Line 243-248 …… “Among 362 women with endometriosis, 63 cases (17.4%) underwent unilateral oophorectomy. This group had a significantly higher median (IQR) age (39 [35, 41] vs. 33 [29, 37]), a higher median (IQR) parity (0 [0, 2] vs. 0 [0, 0]), and a higher percentage of non-fertility need (82.3% vs. 65.8%) compared to non-oophorectomy group. To avoid overtreatment, we recommend not performing unilateral oophorectomy, especially in young women, nulliparity, and have a greater need for fertility.” Minor issues: Line 3 (short title): factors, not factor; surgery for endometriosis, not surgery in endometriosis. Response: We already amended as your suggestion. Previous manuscript: Line 3 ….. “Risk factor” ……. “surgery in endometriosis” Revised manuscript: Line 3 …… “Risk factors” ……. “surgery for endometriosis” Line 31 (abstract): with the same or higher VAS; add "or higher". Response: We already amended as your suggestion. Previous manuscript: Line 31 ….. “with the same” Revised manuscript: Line 31 …… “with the same or higher” Line 58 (intro): glands, not gland. Response: We already amended as your suggestion. Previous manuscript: Line 58 ….. “an endometrial gland” Revised manuscript: Line 58 …… “an endometrial glands” Line 69 (intro): add some reference on the general treatment of endometriomas, such as Chapron C et al "Management of ovarian endometriomas", Hum Reprod Update 2002, and Muzii L et al "Management of endometriomas", Semin Reprod Med 2017. Response: We already amended as your suggestion. Previous manuscript: Line 69 ….. “[4]” Revised manuscript: Line 70…… “[5–7]” Line 335-340 ……“6. Chapron C, Vercellini P, Barakat H, Vieira M, Dubuisson JB. Management of ovarian endometriomas. Hum Reprod Update. 2002; 8(6): 591-597. https://doi.org/doi: 10.1093/humupd/8.6.591 PMID: 12498427 7. Muzii L, Di Tucci C, Di Feliciantonio M, Galati G, Verrelli L, Donato VD, et al. Management of Endometriomas. Semin Reprod Med. 2017; 35(1): 25-30. doi: https://doi.org/10.1055/s-0036-1597126 PMID: 27926971” Line 81 (intro): too many references to attest the high endometriosis load of the Authors (refs 17, 18, 19). Select only one of the three. Ref 20 is on the other hand appropriate in the text. Response: We already amended and delete the reference No. 17-19 and selected only reference No. 21 as your suggestion. Previous manuscript: Line 81-82 ….. “years [17–19].A previous study by Cheewadhanaraks et al. (2013) [20] in our hospital showed that” Line 359-369…. “17. Cheewadhanaraks S, Choksuchat C, Wattanakumtornkul S. Estrogen plus progestin versus estrogen after definitive surgery for endometriosis: a study of pain recurrence. J Med Assoc Thai. 2013; 96(8): 881–887. PMID: 23991592 18. Cheewadhanaraks S, Choksuchat C, Dhanaworavibul K, Liabsuetrakul T. Postoperative depot medroxyprogesterone acetate versus continuous oral contraceptive pills in the treatment of endometriosis-associated pain: a randomized comparative trial. Gynecol Obstet Invest. 2012; 74(2): 151–156. https://doi.org/10.1159/000337713 PMID: 22722530 19. Cheewadhanaraks S, Peeyananjarassri K, Choksuchat C, Dhanaworavibul K, Choobun T, Bunyapipat S. Interval of injections of intramuscular depot medroxyprogesterone acetate in the long-term treatment of endometriosis-associated pain: a randomized comparative trial. Gynecol Obstet Invest. 2009; 68(2): 116–121. https://doi.org/10.1159/000226090 PMID: 19556801” Revised manuscript: Line 83-86 ……. “years and our previous study showed that the cumulative recurrence rates of pain after depot medroxyprogesterone acetate (DMPA) treatment at months 12, 24, 36, 48, and 60 were 18%, 28%, 41%, 46%, and 50%, respectively [20].” Line 264 (discussion): close follow-up, not closed Response: We already amended as your suggestion. Previous manuscript: Line 264 ….. “closed” Revised manuscript: Line 264 …… “close” Reviewer #2: Dear author, thank you for the opportunity to analyze this interesting study on such a widespread pathology. However, I believe that some elements should be specified in the introduction: - endometriosis can be responsible for symptoms even in the menopausal age, varying between 2 and 5% of cases [you can cite: M M Ianieri et al. Retroperitoneal endometriosis in postmenopausal woman causing deep vein thrombosis: case report and review of the literature] Response: We already amended as your suggestion. Previous manuscript: - Revised manuscript: Line 60-61 ……“Uncommonly, it was found to vary between 2% and 5% in menopausal women [3].” Line 326-328….. “3. Ianieri MM, Buca DIP, Panaccio P, Cieri M, Francomano F, Liberati M. Retroperitoneal endometriosis in postmenopausal woman causing deep vein thrombosis: case report and review of the literature. Clin Exp Obstet Gynecol. 2017; 44(1): 148-150. PMID: 29714887.” - I suggest specifying that the recurrence rate of endometriosis also varies according to the definition of recurrence among the various authors Response: We already amended as your suggestion. Previous manuscript: Line 70-71 ….. “The 2-year and overall recurrence rates of endometriosis after conservative surgery were 9–29% and 13–30%, respectively [5–8]. Revised manuscript: Line 71-73 ……“ The recurrence rates of endometriosis after conservative surgery varied according to the definition of recurrence and were reported as 9–29% and 13–30% at 2-year and overall recurrence rates, respectively [8–11].” In the discussion session: - advice to improve and enrich the discussion about the potential role of deep endometriosis on disease recurrence, particularly if radical surgery has not been performed. It would in fact be suggested to specify this aspect in the results or even in the tables. In particular, it would be interesting to know in your series the incidence of endometriosis of the parameters which can often be associated with ovarian endometriosis and whose non-treatment can be associated with persistence/recurrence of symptoms [Ianieri MM et al. Impact of nerve-sparing posterolateral parametrial excision for deep infiltrating endometriosis on postoperative bowel, urinary, and sexual function]. You cannot speak of ovarian recurrence without specifying the possible infiltration of the parameters which are anatomical structures adjacent to the ovaries Response: We already amended as your suggestion. Previous manuscript: - Revised manuscript: Line 264-275 ……“In the present study, endometrioma was the most common finding (86.7%), co-existing with the presence of obliterate cul-de-sac (75.4%), uterosacral ligament involvement (53.2%), and deep endometriosis (23.2%). Previous studies showed higher incidences of co-existing uterosacral ligament involvement (73.8%) and deep endometriosis (43.2%) [31, 32]. These discrepancies may be attributed to the study design, which had missing data (64% and 81% in uterosacral ligament involvement and deep endometriosis, respectively) and all of the operative finding scores based on rAFS classification. Although rAFS classification is accepted and correlates to surgical complexity, Enzian classification is suitable for defining deep endometriosis [33]. Lanieri et al. (2022) [34] demonstrated that parametrectomy significantly improved the symptoms of dyschezia, dysmenorrhea, dysuria, dyspareunia, and chronic pelvic pain but worsened female sexual dysfunction. The failure to detect deep endometriosis resulted in undertreatment and, ultimately, a lack of improvement in their symptoms.” Line 430-443….. “31. Hajati A, Hajati O. A review of more than 2000 cases of site-specific pelvic endometriosis rates by MRI: a guide to minimizing under/overdiagnosis non-invasively. Insights Imaging 2022; 13(1): 129. https://doi.org/10.1186/s13244-022-01270-z PMID: 35939136 32. Piriyev E, Schiermeier S, Römer T. Coexistence of endometriomas with extraovarian endometriosis and adhesions. Eur J Obstet Gynecol Reprod Biol. 2021; 263: 20–24. https://doi.org/10.1016/j.ejogrb.2021.05.044 PMID: 34144489 33. Hudelist G, Valentin L, Saridogan E, Condous G, Malzoni M, Roman H, et al. What to choose and why to use - a critical review on the clinical relevance of rASRM, EFI and Enzian classifications of endometriosis. Facts Views Vis Obgyn. 2021; 13(4): 331–338. https://doi.org/10.52054/FVVO.13.4.041 PMID: 35026095 34. Ianieri MM, Raimondo D, Rosati A, Cocchi L, Trozzi R, Maletta M, et al. Impact of nerve-sparing posterolateral parametrial excision for deep infiltrating endometriosis on postoperative bowel, urinary, and sexual function. Int J Gynaecol Obstet. 2022; 159(1): 152–159. https://doi.org/10.1002/ijgo.14089. PMID: 34995374” ________________________________________ 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No Response: Thank you for your thoughtful comments. Additionally, we have some changes about the 2-year recurrence rate of endometriosis; the percentage is incorrect. We have already rechecked and amended. Previous manuscript: Line 39, 45, 167, 202, 274…….. “24.3%” Line 167……. “88” Revised manuscript: Line 39, 45, 169, 204, 294….. “23.2%” Line 169……. “84” Finally, because two references were included in this revised manuscript (references no. 5 and 6), the next references were re-arranged as follows: Previous manuscript Revised manuscript Reference No. 3 4 4 5 5 8 6 9 7 10 8 11 9 12 10 13 11 14 12 15 13 16 14 17 15 18 16 19 17 delete 18 delete 19 delete Attachments Attachment Submitted filename: Response to Reviewers-15 July 2023.docx https://doi.org/10.1371/journal.pone.0289832.r002
27 Jul 2023 Decision Letter - Diego Raimondo, Editor Risk factors for recurrent endometriosis after conservative surgery in a quaternary care center in southern Thailand PONE-D-22-29483R1 Dear Dr. Klangsin, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Diego Raimondo Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0289832.r003
Formally Accepted
1 Aug 2023 Acceptance Letter - Diego Raimondo, Editor PONE-D-22-29483R1 Risk factors for recurrent endometriosis after conservative surgery in a quaternary care center in southern Thailand Dear Dr. Klangsin: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Diego Raimondo Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0289832.r004

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