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Surgical management and outcome of metachronous Krukenberg tumors from gastric cancer
Author(s) -
Cheong Jae Ho,
Hyung Woo Jin,
Chen Jian,
Kim Junuk,
Choi Seung Ho,
Noh Sung Hoon
Publication year - 2004
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.20072
Subject(s) - medicine , krukenberg tumor , cancer , surgery , confidence interval , prospective cohort study , pelvis , ovarian cancer , metastasis
Background and Objectives The question of whether resection should be performed in Krukenberg tumors from gastric cancer has yet to be adequately examined. Despite some reports on the surgical treatment of Krukenberg tumors, the outcomes after resection are not well characterized. Patients and Methods Using a gastric cancer database, a total of 34 patients who underwent a resection of metastatic ovarian tumors after curative surgery for gastric cancer were identified. A prospective database of these patients was reviewed for the presentation, clinical features, and outcomes after resection. Results The median age of 34 patients was 44 years (range, 24–66). The majority of patients was in the premenopausal state and had bilateral ovarian involvement. The most common presenting symptom was an abdominal mass (35.3%). Tumor size ranged from 3.5 to 20 cm with 61.8% measuring larger than 10 cm. In 17 patients who had metastatic disease confined to the pelvis, a complete gross resection (R0) was achieved. In the other 17 with the disease beyond the pelvis gross residual tumors remained after the resection (R1). The median survival of all patients was 11 months (95% confidence interval [CI] 8–14), and that of the patients rendered R0 was 18 months (95% CI, 14–22), in comparison with 9 months (95% CI, 3–15) for those with R1 resection ( P = 0.0001; log‐rank test). The median progression free survival was also significantly longer for the patients with R0 resection than those with R1 resection (8 months, 95% CI, 5–11 vs. 5 months, 95% CI, 4–6, P = 0.0103). Multivariate analysis identified R0 resection as the only significant factor predictive of survival. Conclusions In the management of Krukenberg tumors after gastric cancer, a metastasectomy may significantly improve the overall and progression free survival if it could render a complete gross resection. To define the patient group that benefits most from resection, the extent of disease and resectability must be carefully evaluated before surgery. J. Surg. Oncol. 2004;87:39–45. © 2004 Wiley‐Liss, Inc.