Skip to main content
SpringerLink
Log in

Krukenberg Tumors of Gastric Origin: The Rationale of Surgical Resection and Perioperative Treatments in a Multicenter Western Experience

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Krukenberg FE (1896) Űber Das Fibrosarcoma ovarii mucocellulare (carcinomatodes). Arch Gynäkol 50:287–321

    Article  Google Scholar 

  2. Schlagenhaufer F (1902) Ueber das metastatische ovarial-carcinom nach Krebs des Magens, Darmes, und anderer Bauchorgane. Monatschr F Geburtsh U Gynäckol 1:485–528

    Google Scholar 

  3. Wang J, Shi YK, Wu LY et al (2008) Prognostic factors for ovarian metastases from primary gastric cancer. Int J Gynecol Cancer 18:825–832

    Article  CAS  PubMed  Google Scholar 

  4. Kim HK, Heo DS, Bang YJ, Kim NK (2001) Prognostic factors of Krukenberg’s tumor. Gynecol Oncol 82:105–109

    Article  CAS  PubMed  Google Scholar 

  5. Man M, Cazacu M, Oniu T (2007) Krukenberg tumors of gastric origin versus Krukenberg tumors of colorectal origin. Chirurgia (Bucur) 102(4):407–410

    CAS  Google Scholar 

  6. McGill F, Ritter DB, Rickard C et al (1998) Management of Krukenberg tumors: an 11-year experience and review of the literature. Prim Care Update Ob Gyns 5(4):157–158

    Article  PubMed  Google Scholar 

  7. Kiyokawa T, Young RH, Scully RE (2006) Krukenberg tumors of the ovary: a clinicopathologic analysis of 120 cases with emphasis on their variable pathologic manifestations. Am J Surg Pathol 30(3):277–299

    PubMed  Google Scholar 

  8. Papakonstantinou E, Liapis A, Kairi-Vassilatou E et al (2011) Virilizing ovarian Krukenberg tumor in a 27-year-old pregnant woman. A case report and literature review. Eur J Gynaecol Oncol 32(3):331–333

    CAS  PubMed  Google Scholar 

  9. Novak E, Gray LA (1938) Krukenberg tumors of the ovary. Clinical and pathological study of 21 cases. Surg Gynecol Obstet 66:157–167

    Google Scholar 

  10. Cheong JH, Hyung WJ, Chen J et al (2004) Survival benefit of metastasectomy for Krukenberg tumors from gastric cancer. Gynecol Oncol 94:477–482

    Article  PubMed  Google Scholar 

  11. Cheong J, Hyung WJ, Chen J et al (2004) Surgical management and outcome of metachronous Krukenberg tumors from gastric cancer. J Surg Oncol 87:39–45

    Article  PubMed  Google Scholar 

  12. Japanese Gastric Cancer Association (1998) Japanese classification of gastric carcinoma, 2nd English edition. Gastric Cancer 1:10–24

    Article  PubMed  Google Scholar 

  13. Sobin LH, Wittekind C, Gospodarowicz M (eds) (2009) TNM classification of malignant tumors (UICC), 7th edn. Wiley, New York, pp 73–77

    Google Scholar 

  14. Baiocchi GL, Marrelli D, Verlato G et al (2014) Follow-up after gastrectomy for cancer: an appraisal of the Italian research group for gastric cancer. Ann Surg Oncol 21(6):2005–2011

    PubMed  Google Scholar 

  15. Kim WY, Kim TJ, Kim SE et al (2010) The role of cytoreductive surgery for non-genital tract metastatic tumors to the ovaries. Eur J Obstet Gynecol Reprod Biol 149(1):97–101

    Article  PubMed  Google Scholar 

  16. Yoo CH, Noh SH, Shin DW et al (2000) Recurrence following curative resection for gastric carcinoma. Br J Surg 87:236–242

    Article  CAS  PubMed  Google Scholar 

  17. Kim NK, Kim HK, Park BJ et al (1999) Risk factors for ovarian metastasis following curative resection of gastric adenocarcinoma. Cancer 85:1490–1499

    Article  CAS  PubMed  Google Scholar 

  18. Al-Agha OM, Nicastri AD (2006) An in-depth look at Krukenberg tumor: an overview. Arch Pathol Lab Med 130(11):1725–1730

    PubMed  Google Scholar 

  19. Lu LC, Shao YY, Hsu CH et al (2012) Metastasectomy of Krukenberg tumors may be associated with survival benefits in patients with metastatic gastric cancer. Anticancer Res 32:3397–3401

    PubMed  Google Scholar 

  20. Mrad K, Morice P, Fabre A et al (2000) Krukenberg tumor: a clinico-pathological study of 15 cases. Ann Pathol 20:202–206

    CAS  PubMed  Google Scholar 

  21. Savey L, Lasser P, Castaigne D et al (1996) Krukenberg tumors. Analysis of a series of 28 cases. J Chir (Paris) 133:427–431

    CAS  Google Scholar 

  22. Pacelli F, Cusumano G, Rosa F et al (2013) Multivisceral resection for locally advanced gastric cancer: an Italian multicenter observational study (On behalf of the Italian Research Group for Gastric Cancer – IRGGC). JAMA Surg 148:353–360

    Article  PubMed  Google Scholar 

  23. Cho JH, Lim JY, Choi AR et al (2014) Comparison of surgery plus chemotherapy and palliative chemotherapy alone for advanced gastric cancer with krukenberg Tumor. Cancer Res Treat. doi:10.4143/crt.2013.175

    Google Scholar 

  24. Preusser P, Wilke H, Achterrath W et al (1989) Phase II study with the combination etoposide, doxorubicin, and cisplatin in advanced measurable gastric cancer. J Clin Oncol 7:1310–1317

    CAS  PubMed  Google Scholar 

  25. Di Giorgio A, Pinto E (eds) (2015) Treatment of peritoneal surface malignancies. State of the art and perspectives. Springer-Verlag XVI, Berlin

    Google Scholar 

  26. Yang XJ, Huang CQ, Suo T et al (2011) Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy improve survival of patients with peritoneal carcinomatosis from gastric cancer: final results of a phase III randomized clinical trial. Ann Surg Oncol 34:1246–1252

    Google Scholar 

Download references

Acknowledgments

We thank Dr. M. Covino (Emergency Department, Catholic University of Rome) for his precious suggestions for the statistical analyses.

Author information

Authors and Affiliations

  1. Department of Digestive Surgery, Catholic University of Rome, Rome, Italy

    Fausto Rosa, Giovanni Battista Doglietto & Fabio Pacelli

  2. Institute of Surgical Sciences, University of Siena, Siena, Italy

    Daniele Marrelli & Franco Roviello

  3. Division of Surgery, “G.B. Morgagni, L. Pierantoni” Hospital, Forlì, Italy

    Paolo Morgagni & Giovanni Vittimberga

  4. 1st Division of Surgery, “Borgo Trento” Hospital, University of Verona, Verona, Italy

    Chiara Cipollari & Giovanni de Manzoni

  5. Department of Surgery and Advanced Cancer Therapies, Morgagni-Pierantoni Hospital, Forlì, Italy

    Massimo Framarini

  6. Division of Surgical Oncology, IRCCS Istituto Clinico Humanitas, Rozzano, Milan, Italy

    Luca Cozzaglio

  7. General Surgery A, “Borgo Roma” Hospital, University of Verona, Verona, Italy

    Corrado Pedrazzani

  8. Surgical Oncology, John Paul II Foundation, Campobasso, Italy

    Stefano Berardi

  9. Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy

    Gian Luca Baiocchi & Nazario Portolani

  10. Department of Digestive Endoscopy, Catholic University of Rome, Rome, Italy

    Guido Costamagna

  11. Department of Digestive Surgery, Catholic University - “A. Gemelli” Hospital, Largo A. Gemelli, 8, 00168, Rome, Italy

    Fausto Rosa

Authors
  1. Fausto Rosa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Daniele Marrelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Paolo Morgagni
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chiara Cipollari
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Giovanni Vittimberga
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Massimo Framarini
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Luca Cozzaglio
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Corrado Pedrazzani
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Stefano Berardi
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Gian Luca Baiocchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Franco Roviello
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Nazario Portolani
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Giovanni de Manzoni
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Guido Costamagna
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Giovanni Battista Doglietto
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Fabio Pacelli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fausto Rosa.

Ethics declarations

Conflict of interest

No conflict of interest to declare.

Disclosure

The results of this manuscript were presented as Oral Presentation at the 11th International Gastric Cancer Congress held in São Paulo (Brazil), June 3rd–6th, 2015.

Additional information

On behalf of GIRCG/SICO (Gruppo Italiano di Ricerca per il Cancro Gastrico / Società Italiana di Chirurgia Oncologia).

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rosa, F., Marrelli, D., Morgagni, P. et al. Krukenberg Tumors of Gastric Origin: The Rationale of Surgical Resection and Perioperative Treatments in a Multicenter Western Experience. World J Surg 40, 921–928 (2016). https://doi.org/10.1007/s00268-015-3326-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-015-3326-8

Keywords

Search

Navigation