World Journal of Surgery

, Volume 40, Issue 4, pp 921–928 | Cite as

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

  • Fausto RosaEmail author
  • Daniele Marrelli
  • Paolo Morgagni
  • Chiara Cipollari
  • Giovanni Vittimberga
  • Massimo Framarini
  • Luca Cozzaglio
  • Corrado Pedrazzani
  • Stefano Berardi
  • Gian Luca Baiocchi
  • Franco Roviello
  • Nazario Portolani
  • Giovanni de Manzoni
  • Guido Costamagna
  • Giovanni Battista Doglietto
  • Fabio Pacelli
Original Scientific Report



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.


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.


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.


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.


Gastric Cancer Peritoneal Carcinomatosis Systemic Compute Tomography Peritoneal Recurrence Ovarian Metastasis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



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

Compliance with ethical standards

Conflict of interest

No conflict of interest to declare.


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.


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Copyright information

© Société Internationale de Chirurgie 2015

Authors and Affiliations

  • Fausto Rosa
    • 1
    • 11
    Email author
  • Daniele Marrelli
    • 2
  • Paolo Morgagni
    • 3
  • Chiara Cipollari
    • 4
  • Giovanni Vittimberga
    • 3
  • Massimo Framarini
    • 5
  • Luca Cozzaglio
    • 6
  • Corrado Pedrazzani
    • 7
  • Stefano Berardi
    • 8
  • Gian Luca Baiocchi
    • 9
  • Franco Roviello
    • 2
  • Nazario Portolani
    • 9
  • Giovanni de Manzoni
    • 4
  • Guido Costamagna
    • 10
  • Giovanni Battista Doglietto
    • 1
  • Fabio Pacelli
    • 1
  1. 1.Department of Digestive SurgeryCatholic University of RomeRomeItaly
  2. 2.Institute of Surgical SciencesUniversity of SienaSienaItaly
  3. 3.Division of Surgery“G.B. Morgagni, L. Pierantoni” HospitalForlìItaly
  4. 4.1st Division of Surgery, “Borgo Trento” HospitalUniversity of VeronaVeronaItaly
  5. 5.Department of Surgery and Advanced Cancer TherapiesMorgagni-Pierantoni HospitalForlìItaly
  6. 6.Division of Surgical OncologyIRCCS Istituto Clinico HumanitasRozzanoItaly
  7. 7.General Surgery A, “Borgo Roma” HospitalUniversity of VeronaVeronaItaly
  8. 8.Surgical OncologyJohn Paul II FoundationCampobassoItaly
  9. 9.Department of Clinical and Experimental Sciences, Surgical ClinicUniversity of BresciaBresciaItaly
  10. 10.Department of Digestive EndoscopyCatholic University of RomeRomeItaly
  11. 11.Department of Digestive SurgeryCatholic University - “A. Gemelli” HospitalRomeItaly

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