Balancing ovarian preservation and recurrence risk: A systematic review and meta-analysis of cystectomy versus ablative methods in endometrioma management.

Authors

P Romeo, A Tassone, L Bonanno, G Vizzielli, S Restaino, C Ronsini, V Chiantera, R Granese, S Cianci

Published in

European journal of obstetrics, gynecology, and reproductive biology. Volume 325. Pages 115288. Jul 06, 2026. Epub Jul 06, 2026.

Abstract

To compare cystectomy and ablative surgical techniques for the treatment of ovarian endometrioma, focusing on recurrence, ovarian reserve, and fertility outcomes.
This systematic review and meta-analysis was conducted according to PRISMA 2020 guidelines and prospectively registered in PROSPERO (CRD420261342497). PubMed and Scopus were searched from January 2000 to September 2025. Studies comparing cystectomy with ablative techniques (CO₂ laser, argon plasma coagulation, PlasmaJet, bipolar energy, or hybrid approaches) in women with ovarian endometrioma ≥3 cm were included. Random-effects models were used to calculate pooled risk ratios (RRs) for dichotomous outcomes and mean differences (MDs) for continuous outcomes.
Twelve studies were included, with 4-6 studies contributing to each meta-analysis depending on outcome availability. Cystectomy showed a trend toward lower recurrence compared with ablative techniques (RR 0.61, 95% CI 0.37-1.01; p = 0.054), although this did not reach statistical significance. Ablative techniques were associated with better preservation of ovarian reserve, with a significantly smaller decline in antral follicle count (MD - 1.96, 95% CI - 3.04 to - 0.88; p < 0.001), while no significant difference was observed in anti-Müllerian hormone levels (MD - 0.24, 95% CI - 0.69 to 0.21; p = 0.30). No significant differences were found in overall pregnancy (RR 1.02), spontaneous conception (RR 1.02), or ART/IVF pregnancy rates (RR 0.83).
Cystectomy may reduce recurrence risk, whereas ablative techniques better preserve ovarian reserve. However, neither approach appears to confer a significant advantage in fertility outcomes. Surgical management of ovarian endometrioma should be individualized based on patient characteristics and reproductive goals.

PMID:
42424709
Bibliographic data and abstract were imported from PubMed on 10 Jul 2026.

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