Fausto Rosa1,2, Daniele Marrelli3, Paolo Morgagni4, Chiara Cipollari5, Giovanni Vittimberga4, Massimo Framarini6, Luca Cozzaglio7, Corrado Pedrazzani8, Stefano Berardi9, Gian Luca Baiocchi10, Franco Roviello3, Nazario Portolani10, Giovanni de Manzoni5, Guido Costamagna11, Giovanni Battista Doglietto12, Fabio Pacelli12. 1. Department of Digestive Surgery, Catholic University of Rome, Rome, Italy. faust.rosa@tiscali.it. 2. Department of Digestive Surgery, Catholic University - "A. Gemelli" Hospital, Largo A. Gemelli, 8, 00168, Rome, Italy. faust.rosa@tiscali.it. 3. Institute of Surgical Sciences, University of Siena, Siena, Italy. 4. Division of Surgery, "G.B. Morgagni, L. Pierantoni" Hospital, Forlì, Italy. 5. 1st Division of Surgery, "Borgo Trento" Hospital, University of Verona, Verona, Italy. 6. Department of Surgery and Advanced Cancer Therapies, Morgagni-Pierantoni Hospital, Forlì, Italy. 7. Division of Surgical Oncology, IRCCS Istituto Clinico Humanitas, Rozzano, Milan, Italy. 8. General Surgery A, "Borgo Roma" Hospital, University of Verona, Verona, Italy. 9. Surgical Oncology, John Paul II Foundation, Campobasso, Italy. 10. Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy. 11. Department of Digestive Endoscopy, Catholic University of Rome, Rome, Italy. 12. Department of Digestive Surgery, Catholic University of Rome, Rome, Italy.
Abstract
BACKGROUND: In case of Krukenberg tumor (KT) of gastric origin it is controversial and debated whether radical surgery in case of synchronous KT or metastasectomy in case of metachronous ones is associated with additional benefits. Role of perioperative treatments is unclear. METHODS: Among 2515 female patients who were diagnosed with gastric cancer between January 1990 and December 2012 from 9 Italian centers, 63 presented simultaneously or developed KT as recurrence. RESULTS: Thirty patients presented with synchronous KT, while 33 developed metachronous ovarian metastases during follow-up. The differences between the two groups were analyzed and compared. The median age of 63 patients was 48.0 years (range 31-71). Resection was possible in 53 patients (20 synchronous and 33 metachronous). Twelve patients in the synchronous group and 15 patients of the metachronous group underwent hyperthermic intraperitoneal chemotherapy after resection of KT. All of them underwent adjuvant chemotherapy after KT resection. The median survival for all population was 23 months (95 % confidence interval, 7-39 months). The median survival time in the metachronous group was 36 months, which was significantly longer than that in the synchronous group, 17 months, p < 0.0001. CONCLUSIONS: KT remains a clinical challenge for gastric cancer therapy. The extent of disease and feasibility of removal of the metastatic lesion must be carefully evaluated prior to surgery to define the patients group who could benefit most from a resection associated with perioperative treatments.
BACKGROUND: In case of Krukenberg tumor (KT) of gastric origin it is controversial and debated whether radical surgery in case of synchronous KT or metastasectomy in case of metachronous ones is associated with additional benefits. Role of perioperative treatments is unclear. METHODS: Among 2515 female patients who were diagnosed with gastric cancer between January 1990 and December 2012 from 9 Italian centers, 63 presented simultaneously or developed KT as recurrence. RESULTS: Thirty patients presented with synchronous KT, while 33 developed metachronous ovarian metastases during follow-up. The differences between the two groups were analyzed and compared. The median age of 63 patients was 48.0 years (range 31-71). Resection was possible in 53 patients (20 synchronous and 33 metachronous). Twelve patients in the synchronous group and 15 patients of the metachronous group underwent hyperthermic intraperitoneal chemotherapy after resection of KT. All of them underwent adjuvant chemotherapy after KT resection. The median survival for all population was 23 months (95 % confidence interval, 7-39 months). The median survival time in the metachronous group was 36 months, which was significantly longer than that in the synchronous group, 17 months, p < 0.0001. CONCLUSIONS: KT remains a clinical challenge for gastric cancer therapy. The extent of disease and feasibility of removal of the metastatic lesion must be carefully evaluated prior to surgery to define the patients group who could benefit most from a resection associated with perioperative treatments.
Authors: E Papakonstantinou; A Liapis; E Kairi-Vassilatou; C Iavazzo; C K Kleanthis; A Kondi-Pafiti Journal: Eur J Gynaecol Oncol Date: 2011 Impact factor: 0.196
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