Table 2 Characteristics and outcomes of the included studies evaluating the effect of the surgical treatment for endometriosis on QoL

Angioni et al. 2015 [78]

Randomized clinical trial

159

Laparoscopic en-block resection of DIE vs. incomplete surgical treatment with or without GnRHa administration after surgery

Deep infiltrating endometriosis of the cul-de-sac and of the rectovaginal septum

At 1-year follow-up patients treated with en-block resection showed significant improvement in physical function (p < 0.01), general health (p < 0.01) and vitality (p < 0.01) in comparison to baseline and to 12 months follow-up of the patients who underwent an incomplete surgical treatment. GnRHa administration is followed by a temporary improvement of pain in patients with incomplete surgical treatment.

SF-36

Bassi et al. 2011 [68]

Prospective study

151

Laparoscopic segmental rectosigmoid resection

Deep infiltrating endometriosis with bowel involvement

One year after the bowel resection, there was a significant increase (p < 001) in scores in all SF-36 domains, as well as in the sum of the components comprising both physical health and mental health recorded before and after the surgical procedure.

SF-36

Byrne et al. 2018 [71]

Multicenter prospective cohort study

4721

25.9-44.8

Laparoscopic surgical excision of rectovaginal endometriosis requiring dissection of the pararectal space.

Rectovaginal endometriosis

Global quality of life significantly improved at 6 months. There was a significant improvement in quality of life in all measured domains and in quality-adjusted life years. These improvements were sustained at 2 years.

EQ-5D

Comptour et al. 2019 [65]

Prospective and multicenter cohort study

981

15-50

Laparoscopic treatment

Not specified

Improvement was observed for all the SF-36 dimensions at 6 months after surgery, and this improvement remained stable over several years.

SF-36

Daraï et al. 2010 [75]

Randomized trial

52

n = 26 laparoscopically assisted

n = 26 open surgery group

25-44

Laparoscopically assisted vs open colorectal resection

Colorectal endometriosis

The median follow-up was 19 months.

Except for physical functioning, all the items of the SF-36 questionnaires were improved after surgery for the whole population. An improvement in PCS (P = 0.0001) and MCS (P < 0.0001) scores of the SF-36 questionnaire was noted after surgery. No difference in delta of PCS and MCS scores of the SF-36 questionnaire was observed between the groups.

SF-36

Deguara et al. 2013 [64]

Prospective study

21

18-50

Laparoscopic surgery

Not specified

Therapeutic laparoscopic surgery shows benefits in the symptoms and psyche of patients with endometriosis.

SF-36;

SF-12

Kent et al. 2016 [77]

Prospective Cohort Study

137 patients had surgery, of which 100 completed follow-up

Laparoscopic surgery:

2-stage procedure with interval downregulation using GnRH analogs.

Severe rectovaginal endometriosis compromising the bowel

Surgery by an experienced multidisciplinary team results in significant improvement in pain, sexual function, and quality of life up to 1 year postoperatively. Pelvic clearance improves outcome.

EHP-30;

EQ-5D

Mabrouk et al. 2011 [67]

Prospective cohort study

100

23-39

Laparoscopic surgery

DIE

Six months postoperatively all the women had a significant improvement in every scale of the SF-36 (p < 0.0005).

SF-36

Meuleman et al. 2014 [79]

Prospective Cohort study

203

n = 76

Study group: patients with DIE receiving bowel resection

n = 127

Control group: subgroup with or without DIE not receiving bowel resection

20-47

CO2 laser ablative surgery with bowel resection and without bowel resection

Extensive DIE with colorectal extension

In both groups, EHP30 scores improved significantly and remained stable for 24 months after surgery. No differences were observed between study and control groups.

EHP-30

Misra et al. 2020 [80]

Parallel-group randomized controlled trial.

192 patients

n = 96 Diathermy

n = 96

Helium

16-50

Laparoscopic ablation or excision with helium thermal coagulator vs hook electrodiathermy

Not specified

Small but statistically significant differences in some quality-of-life measures (pain, emotional wellbeing and self-image) also favored the use of electrodiatherm.

EHP-30

Pontis et al. 2016 [82]

Prospective observational study

16

Combined transurethral and laparoscopic approach

Symptomatic bladder endometriosis

At one year follow up, patients showed significant improvement in physical function (p < 0.01), in general health (p < 0.00021), in physical (p < 0.0003) and emotional roles (p < 0.03), in mental health (p < 0.004), and vitality (p < 0.0013), in comparison to baseline (pre-surgery)

SF-36;

Ribeiro et al. 2014 [74]

Prospective observational cohort study

45

Laparoscopic colorectal segment resection

Intestinal deep endometriosis

At 6 months post-operatively and 1 year post-operatively significant improvements were observed in all domains of the SF-36 (p < 0.05). Physical health-related QOL domains showed greater improvement than mental health domains.

SF-36

Riiskjær 2018 [70]

Prospective observational study

175

Laparoscopic bowel resection

Rectosigmoid endometriosis

A total of 97.1% of the women completed the 1-year follow up (170). A significant improvement on all quality-of-life scores was observed (p = 0.0001).

SF-36

Roman et al. 2018 [72]

2-arm randomized

controlled trial

60

n = 27

Conservative surgery

n = 33

Segmental resection

27-36

Conservative surgery, by shaving or disk excision, vs radical rectal surgery, by segmental resection

Deep endometriosis infiltrating the rectum

The intention-to-treat comparison of the overall scores on SF36 did not reveal significant differences between the two arms 2 years postoperatively.

SF-36

Roman et al. 2019 [73]

2-arm randomized controlled trial

60

n = 27

Conservative surgery

n = 33

Segmental resection

27-36

Conservative surgery, by shaving or disk excision, or radical rectal surgery, by segmental resection

Deep endometriosis infiltrating the rectum

There is an overall improvement in pelvic pain and quality of life after surgery, which is comparable between the two arms and remains constant during the 5 years of follow-up.

SF-36

Silveira da Cunha Araùjo et al. 2014 [69]

Observational prospective cohort study

36

Laparoscopic treatment for deep infiltrative endometriosis with colorectal resection

Bowel endometriosis

Analysis of each domain revealed improved quality of life when comparing the period before surgery with 12 and 48 months after surgery. There was a significant increase (p < 0.001) in the scores in all of the SF-36 domains when comparing T0 vs T12 and T0 vs T48, with higher average scores at T48 corresponding to the domains of physical functioning, role physical, and social functioning

SF-36

Soto et al. 2017 [81]

Multicenter randomized controlled trial

73

n=38 Laparoscopic group

n=35

Robotic group

Laparoscopic versus robotic surgery

Not specified

EHP-30: all parameters improved compared with baseline at 6 weeks and 6 months. No statistical differences were found between groups when each parameter was compared at baseline, 6 weeks, or 6 months on univariate analysis. The physical and mental health component of the SF-12 did not change significantly compared with baseline. When compared across all time points using a linear mixed model, there were no differences between groups

SF-12; EHP-30

Touboul et al. 2015 [76]

Randomized controlled trial

40

n = 20 laparoscopically assisted group

n = 20

open surgery group

25-44

Laparoscopically assisted vs open colorectal resection

Colorectal endometriosis

QOL was significantly improved after surgery and remained stable over 4 years All dimensions of the SF-36 were increased postoperatively and remained steady over 4 years except for physical functioning (PF) which increased without reaching statistical significance

No difference in QOL was observed between the groups

SF-36

Valentin et al. 2017 [66]

Prospective and multicenter observational study

161

15-50

Laparoscopic procedure

Minimal endometriosis (rAFS score < 6)

The study shows 86% of failure of surgery to improve QOL. Surgery is seldom a good option to increase QOL for patients with minimal endometriosis.

SF-36