Ovarian metastasis from colorectal cancer: Prognostic value of radical oophorectomy

Erroi, Francesca; Scarpa, Marco; Angriman, Imerio; Cecchetto, Attilio; Pasetto, Lara Maria; Mollica, Eleonora; Bettiol, Marina; Ruffolo, Cesare; Polese, Lino; Cillo, Umberto; D’Amico, Davide

doi:10.1002/jso.20803

Cited by 62 publications

(47 citation statements)

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“…The role of metastasectomy for Krukenberg tumor was assessed between different primary cancer types, different types of surgery or extent of residual disease. Bilateral oophorectomy for Krukenberg tumor have been shown to positively affect OS in isolated ovarian metastasis patients in an Italian study (21). Cheong et al (22) reported on 54 patients with Krukenberg tumors who experienced disease relapse following curative surgery of primary gastric cancer.…”

Section: Univariate Analysis Multivariate Analysis ------------------mentioning

confidence: 99%

Clinical characteristics and prognostic analysis of Krukenberg tumor

Zhao

et al. 2015

Molecular and Clinical Oncology

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Abstract. Krukenberg tumor is a rare metastastic tumor of the ovary, characterized by poor prognosis. In order to analyze the clinical characteristics and prognostic factors, we retrospectively investigated 128 patients who were diagnosed with Krukenberg tumor between January, 1990 and December, 2010. The median patient age was 48 years. The median overall survival (OS) of Krukenberg tumor for all patients was 16 months (95% CI: 15-19 months). The median OS among patients with Krukenberg tumors of gastric, colorectal, breast and other origins (including appendix, gallbladder, small intestine and unknown primary) was 11, 21.5, 31 and 19.5 months, respectively (P<0.0001). In the univariate analysis, synchronous metastasis, no chemotherapy, ovarian metastasis beyond the pelvis, ascites and no metastasectomy were identified as significant poor prognostic factors. The multivariate analysis suggested that synchronous metastasis (P=0.0080), pelvic invasion (P=0.0138), ascites (P<0.0001) and no metastasectomy (P=0.0060) were independent factors for predicting unfavorable OS. It was suggested that the prognosis of Krukenberg tumor is dismal and ovarian metastasectomy may prove beneficial. Adequate treatment planning is required for this group of patients. IntroductionKrukenberg tumor is a rare metastatic signet ring cell tumor of the ovary, accounting for 1-2% of all ovarian tumors. The stomach is the primary site in the majority of Krukenberg tumor cases, followed by carcinomas of the colon, appendix and breast, particularly invasive lobular carcinoma (1). The eponym was attributed to this tumor following the description of 5 cases by Friedrich Krukenberg (1871-1946) in 1896, who described it as being common among young women, presenting with ascites, an uneven knobby ovarian surface and lymphatic involvement (2). These tumors are characterised by uncertain pathogenesis, challenging etiological diagnosis and poorer prognosis compared with their primaries. Previously, any metastatic ovarian cancer was referred to as Krukenberg tumor; however, Novak and Gray (3) created new diagnostic criteria to eliminate any confusion. Accordingly, a mucin-secreting signet ring cell carcinoma in the dense fibroblastic stroma of the ovary is referred to as Krukenberg tumor. The diagnosis of Krukenberg tumor is currently based on the diagnostic criteria of the World Health Organization based on the pathological description by Serov and Scully (4). The presence of the following characteristics is required for diagnosis: Stromal involvement, mucin-producing neoplastic signet ring cells and ovarian stromal sarcomatoid proliferation.Krukenberg tumor is considered as a late-stage disease with poor prognosis and may account for 30-40% of metastatic cancers to the ovaries (5). The treatment approach to these metastatic ovarian tumors remains controversial. To date, treatment mainly consists of ovarian metastasectomy, chemotherapy or radiotherapy; however, the optimal treatment has not yet been established. As the biological behavior and clinical...

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Section: Univariate Analysis Multivariate Analysis ------------------mentioning

confidence: 99%

Clinical characteristics and prognostic analysis of Krukenberg tumor

Zhao

et al. 2015

Molecular and Clinical Oncology

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“…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].…”

Section: Dear Editormentioning

confidence: 97%

“…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…”

mentioning

confidence: 90%

“…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 involvement of the peritoneum the authoritative suggestions of Sugarbaker should be followed.…”

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confidence: 93%

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Decision making for metastatic diseases to the ovaries from colorectal cancer

Scarpa

Erroi

Ruffolo

et al. 2007

Journal of Surgical Oncology

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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...

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“…We read with great interest a recent paper by Erroi et al [1], studying the potential role for oophorectomy in patients with colorectal cancers metastatic to the ovaries. The authors underline that ovarian metastasis from primary colorectal cancer are observed in up to 8% of women undergoing colorectal resection.…”

Section: The Commonest Primary Sites For Metastatic Disease To the Ovmentioning

confidence: 98%