{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T07:03:06Z","timestamp":1779951786600,"version":"3.53.1"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T00:00:00Z","timestamp":1779926400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study provides a comprehensive analysis of surgically managed thoracic endometriosis syndrome (TES) patients, primarily assessing whether diaphragmatic reconstruction is associated with lower postoperative recurrence. Secondarily, the study aims to evaluate histopathological findings and temporal changes in management of TES at a tertiary care center.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective study of 41 female patients (median age 37) treated surgically for TES between 2012 and 2025 at the Department of Thoracic Surgery, Medical University of Gdansk, Poland. Patients presenting with pneumothorax and\/or symptoms of diaphragmatic endometriosis were stratified into Early and Late periods to evaluate changes in surgical management - video-assisted thoracoscopic surgery (VATS), thoracotomy, thoracolaparoscopy, and the implementation of accurate immunohistochemical histopathological assessment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Complete follow-up was available for 78.0% of patients, however, with differential loss to follow-up between groups (4.5% reconstruction vs. 42.1% no reconstruction;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.006) may have biased results, with the direction of bias depending on the outcomes of patients lost to follow-up. Among patients with complete follow-up, intervention-requiring recurrence occurred in 0% of women with reconstruction versus 27.3% without reconstruction (Fisher exact\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.033). Among patients treated since 2022, diaphragmatic reconstruction was more frequent than in 2012\u20132021 (71.4% vs. 35.0%,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.029). Routine immunohistochemical staining since 2022 improved histopathological confirmation of TES (90% vs. 0%;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In the study, diaphragmatic reconstruction was associated with lower intervention-requiring recurrence, which may indicate a potential benefit of reconstructive techniques in TES surgery. Routine immunohistochemical evaluation (ER, PR, CD10) may be essential for TES diagnosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1835516","type":"journal-article","created":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T06:19:50Z","timestamp":1779949190000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond the pelvis: diagnostic and surgical challenges of thoracic endometriosis syndrome - a retrospective cohort study of 41 patients"],"prefix":"10.3389","volume":"13","author":[{"given":"Natalia","family":"Szczepa\u0144ska","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Medical University of Gdansk","place":["Gdansk, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Przemys\u0142aw","family":"Mi\u0142osz","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Medical University of Gdansk","place":["Gdansk, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafa\u0142","family":"P\u0119ksa","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Department of Clinical Pathomorphology, Medical University of Gdansk","place":["Gdansk, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleksandra","family":"Ciarka","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Department of Clinical Pathomorphology, Medical University of Gdansk","place":["Gdansk, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcin","family":"Folwarski","sequence":"additional","affiliation":[{"name":"Department of Clinical Nutrition and Dietetics, Faculty of Health Sciences with the Institute of Marine and Tropical Medicine, Medical University of Gdansk","place":["Gdansk, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Niedzielska","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Medical University of Gdansk","place":["Gdansk, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Micha\u0142","family":"Szyma\u0144ski","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Department of Surgical Oncology, Transplant and General Surgery, Medical University of Gdansk","place":["Gdansk, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maciej","family":"Wilczy\u0144ski","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Department of Surgical Oncology, Transplant and General Surgery, Medical University of Gdansk","place":["Gdansk, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomasz","family":"Marja\u0144ski","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Department of Thoracic Surgery, Medical University of Gdansk","place":["Gdansk, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,28]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1093\/hropen\/hoac009","article-title":"ESHRE guideline: endometriosis","volume":"2022","author":"Becker","year":"2022","journal-title":"Hum Reprod Open"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1505399","DOI":"10.3389\/fmed.2024.1505399","article-title":"A bird-eye view of diaphragmatic endometriosis: current practices and future perspectives","volume":"11","author":"Naem","year":"2024","journal-title":"Front Med (Lausanne)"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1016\/j.jmig.2019.10.004","article-title":"Extrapelvic endometriosis: a systematic review","volume":"27","author":"Andres","year":"2020","journal-title":"J Minim Invasive 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