Does surgeon expertise influence long-term outcomes in ovarian endometrioma rupture cases?

BACKGROUND: Spontaneous ovarian endometrioma rupture typically presents with acute abdominal pain, a condition often complicated by tissue edema and pelvic adhesions that increase surgical difficulty. This study aims to evaluate the impact of surgical expertise on long-term outcomes in patients with a history of spontaneous ovarian endometrioma rupture. METHODS: This is a retrospective cohort study at Peking Union Medical College Hospital between January 2012 and December 2022, which analyzed patients with spontaneous ovarian endometrioma rupture who underwent surgery. Patients were categorized into specialist or non-specialist surgery groups based on the expertise level of the surgical team. Clinical characteristics, postoperative treatment and recurrence data were collected and compared. Of the 122 patients, 32 were treated by specialists and 90 by non-specialists. All participants received laparoscopic surgery. RESULTS: Baseline characteristics and intraoperative findings were comparable between the two groups. Elective surgery was performed more frequently in the specialist group (81.2%) than in the non‑specialist group (45.6%, p = 0.001). The crude recurrence risk was 15.6% (5/32) in the specialist group, compared with 33.3% (30/90) in the non-specialist group (p = 0.264). Time-to-event analysis demonstrated a significantly lower 10-year cumulative recurrence risk in the specialist group (log-rank p = 0.033). In multivariable Cox regression analysis adjusting for surgery timing, maximum ovarian endometrioma diameter, rASRM score, and treatment duration, specialist surgery remained associated with a lower hazard of recurrence (adjusted HR 0.378, 95% CI 0.140-1.021), although this did not reach statistical significance (p = 0.055). None of the other covariates were significantly associated with recurrence. No between‑group difference was observed in clinical pregnancy rates. CONCLUSIONS: For patients with a history of spontaneous rupture of ovarian endometrioma, surgery performed by specialists with more extensive experience in endometriosis may be associated with a lower long-term recurrence risk. This finding should be interpreted with caution given the borderline statistical significance after Cox adjustment. Nonetheless, the observed trend highlights the potential importance of surgical expertise and the need for specialized training in endometriosis management.