Quality of life improves after endometriosis surgery independent of #ENZIAN classification: a multicenter cohort study

@article{perricoshess2026quality,
  title = {{Quality of life improves after endometriosis surgery independent of #ENZIAN classification: a multicenter cohort study}},
  author = {Alexandra Perricos-Hess and Manuela Gstoettner and Florian Heinzl and Elisabeth Reiser and Olaf Buchweitz and Matthias Jaekel and Elisa Westphal and Stefan Rimbach and Monika Woelfler and Bernhard Kraemer and Thomas Kolben and Sara Dunja Pempelfort and Daria Pashkunova and Julian Metzler and Razvan Petru Derihaci and Petra Klein and Elisabeth Janschek and Philipp Guttenberg and Mathis Wuester and Angelika Wolfrum and Vanadin Seifert-Klauss and Simon-Hermann Enzelsberger and Joerg Keckstein and Beata Seeber and Rene Wenzl},
  journal = {BMC Medicine},
  year = {2026},
  month = aug,
  doi = {10.1186/s12916-026-05136-9},
  url = {https://doi.org/10.1186/s12916-026-05136-9},
  note = {CC BY-NC-ND 4.0},
}

TY  - JOUR
TI  - Quality of life improves after endometriosis surgery independent of #ENZIAN classification: a multicenter cohort study
AU  - Alexandra Perricos-Hess
AU  - Manuela Gstoettner
AU  - Florian Heinzl
AU  - Elisabeth Reiser
AU  - Olaf Buchweitz
AU  - Matthias Jaekel
AU  - Elisa Westphal
AU  - Stefan Rimbach
AU  - Monika Woelfler
AU  - Bernhard Kraemer
AU  - Thomas Kolben
AU  - Sara Dunja Pempelfort
AU  - Daria Pashkunova
AU  - Julian Metzler
AU  - Razvan Petru Derihaci
AU  - Petra Klein
AU  - Elisabeth Janschek
AU  - Philipp Guttenberg
AU  - Mathis Wuester
AU  - Angelika Wolfrum
AU  - Vanadin Seifert-Klauss
AU  - Simon-Hermann Enzelsberger
AU  - Joerg Keckstein
AU  - Beata Seeber
AU  - Rene Wenzl
PY  - 2026
DA  - 2026/08/07
JO  - BMC Medicine
DO  - 10.1186/s12916-026-05136-9
UR  - https://doi.org/10.1186/s12916-026-05136-9
AB  - Background: Endometriosis is a chronic inflammatory disease associated with substantial impairment of quality of life. Although the #ENZIAN classification enables detailed anatomical characterization of disease distribution, its relevance for predicting patient-reported outcomes after surgery remains uncertain. Clarifying this relationship is essential for patient counseling and outcome-oriented surgical decision making.  Methods: This multicenter study, registered on ClinicalTrials.gov (NCT05624567), prospectively recruited consecutive women aged 18 to 50 years undergoing surgery for suspected endometriosis at certified endometriosis centers in Austria, Germany, and Switzerland. Only women with surgically and histopathologically confirmed endometriosis who completed the baseline Endometriosis Health Profile-30 (EHP-30) questionnaire were included in the final analysis. Disease localization was classified intraoperatively using the #ENZIAN and rASRM systems. Quality of life was assessed using the EHP-30 questionnaire preoperatively and at 6 and 12 months after surgery. Longitudinal changes and predictors of quality-of-life outcomes were analyzed using ordinal logistic regression models.  Results: A total of 627 women were included at baseline, with 430 and 325 completing 6- and 12-month follow-up, respectively. Surgical treatment was associated with a marked and clinically meaningful improvement in quality of life, with EHP-30 scores improving significantly within the first 6 months after surgery and remaining stable at 12 months. This improvement was observed consistently across all #ENZIAN compartments, including deep infiltrating and multifocal disease. Anatomical disease distribution and rASRM stage were not significantly associated with baseline quality-of-life or postoperative recovery trajectories. In contrast, baseline symptom burden and complete surgical resection emerged as the strongest predictors of early postoperative quality-of-life improvement.  Conclusions: Surgical treatment of endometriosis was associated with substantial and sustained improvement in patient-reported quality of life, independent of anatomical disease distribution as classified by #ENZIAN. These findings suggest that meaningful postoperative benefit can be achieved across all disease localizations and underscore the importance of focusing on symptom severity and surgical completeness rather than anatomical staging alone. Incorporating patient-reported outcome measures alongside anatomical classification is essential for comprehensive evaluation of treatment success.  Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12916-026-05136-9.
SN  - 1741-7015
ER  -