Functional outcomes after laparoscopic colorectal resection with natural orifice specimen extraction and conventional specimen extraction for deep endometriosis: a 24-month prospective cohort study

OBJECTIVES: To assess changes in bowel function, pain symptoms, and endometriosis-related quality of life over 24 months after laparoscopic colorectal resection with natural orifice specimen extraction (NOSE) and conventional abdominal specimen extraction (CASE) in patients with colorectal endometriosis. Secondary objectives were to investigate the impact of bowel dysfunction and pain severity on gastrointestinal quality of life. MATERIAL AND METHODS: This prospective cohort study included 73 women with colorectal endometriosis who underwent laparoscopic colorectal surgery with NOSE or CASE between 2019 and 2020. Outcomes were assessed preoperatively and at 6, 12, 18, and 24 months postoperatively using the low anterior resection syndrome (LARS) score, Gastrointestinal Quality of Life Index (GIQLI), Endometriosis Health Profile-30 (EHP-30), and Visual Analog Scale (VAS) pain scores. Linear regression analyses were performed to evaluate the possible interaction of bowel dysfunction and pain symptoms preoperatively and 24 months after surgery. RESULTS: A total of 73 patients were included in the analysis. Bowel function followed a characteristic temporal pattern after surgery. Mean LARS scores increased from 12.62 ± 10.72 preoperatively to 15.66 ± 13.54 at 6 months (p = 0.011), followed by significant decreases at 12 months (10.77 ± 10.61, p < 0.001) and 18 months (7.39 ± 7.61, p < 0.001), with stabilization thereafter at 24 months (7.31 ± 7.46 at 24 months, p = 0.380). Gastrointestinal quality of life improved significantly, with GIQLI scores increasing from 98.75 ± 23.68 preoperatively to 111.48 ± 17.70 at 6 months (p < 0.001) and remaining stable at 12 months (114.72 ± 18.60, p = 0.059), 18 months (114.38 ± 18.13, p = 0.443), and 24 months (112.81 ± 18.81, p = 0.181). Mean EHP-30 pain scores decreased markedly from 12.04 ± 12.40 preoperatively to 0.33 ± 0.85 at 6 months (p < 0.001). Although a modest increase was observed between 6 and 12 months (2.82 ± 6.00, p < 0.001), pain scores remained substantially lower than baseline at 24 months (2.40 ± 5.61, p = 0.074). Linear regression analysis demonstrated significant associations between both pain severity and bowel dysfunction with GIQLI. EHP-30 pain scores explained a greater proportion of GIQLI variance than LARS scores both preoperatively (adjusted R² = 0.63 vs 0.046) and at 24 months (adjusted R² = 0.275 vs 0.182). CONCLUSIONS: Laparoscopic colorectal resection for deep endometriosis was associated with favorable 24-month outcomes, including improved gastrointestinal quality of life, endometriosis-related quality of life, and pain symptoms, with bowel function recovering after transient early postoperative deterioration. Long-term GIQLI was more strongly associated with residual pain than with LARS-defined bowel dysfunction, emphasizing pain control as a key determinant of patient-reported outcomes after colorectal surgery for endometriosis.