Decision making for metastatic diseases to the ovaries from colorectal cancer

Abstract

Answer to: ''The commonest primary sites for metastatic disease to the ovaries.'' Dear Editor,We really appreciated the comments to of Dr. Mir et al. [1] who pointed out that probably the colorectal cancer is not the commonest primary site for metastatic disease in the ovaries. Our affirmation that colorectal cancer was the commonest primary site for metastatic disease in the ovaries [2] was based on the report of Spratt [3] and Moore et al.[4] but we acknowledge that more recent series [5,6] reported similar or even higher rate of ovarian metastases from breast cancer.Actually we did not investigate the other common sources of ovarian metastasis since our study was strictly focused on the point of view of the colorectal surgeon. In fact, the primary aim of our study was to evaluate the prognostic value of radical oophorectomy for metastasis from colorectal cancer. The interest of the topic is mainly practical since a surgeon facing to the problem of an ovarian metastasis from breast cancer has the time to plan the following treatment because these localisations are diagnosed at the preoperative staging or at the postoperative follow up. On the contrary, an isolated ovarian metastasis from colorectal cancer is very often an unexpected finding at laparotomy or laparoscopy and it requests an immediate decision about how to proceed. In fact in case of diffuse peritoneal carcinomatosis from colorectal cancer Sugarbaker et al. [7] advocated the cytoreductive surgery with perioperative intraperitoneal chemotherapy and in case of patients who have laparoscopy or laparotomy that demonstrates a peritoneal surface dissemination of cancer should have an immediate halt to further surgical dissection within the abdomen and pelvis. Only when surgical expertise to remove all visible evidence of cancer within the abdomen and pelvis is available should definitive cancer resection occur in association to peritonectomy and perioperative intraperitoneal chemotherapy [7]. Furthermore, Sugarbaker [8] suggest cytoreductive surgery with perioperative intraperitoneal chemotherapy also for colon cancer patients who are at high risk for the development of local-regional recurrence and carcinomatosis such as patients with perforated cancers or with adjacent organ involvement.The rarity of the condition precludes or makes difficult to obtain higher level of clinical evidence than retrospective reports. In our opinion, in the case of isolated ovarian involvement of the colorectal surgeon should go on with the colorectal resection and the oophorectomy without any delay. In fact, the ovarian metastasis more likely originate through a haematogenous spread [2] and they might have different way of diffusion and behaviour than the more aggressive transcoelomic spread of the diffuse carcinomatosis. Furthermore our and other series demonstrated that the simple bilateral oophorectomy can give a discrete prognosis to the patients without adding post operative morbidity [2,9]. On the contrary, in case of ovarian metastasis associated to diffuse involvem...