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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

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.

Keywords

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.

Notes

Acknowledgments

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.

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.

References

  1. 1.
    Krukenberg FE (1896) Űber Das Fibrosarcoma ovarii mucocellulare (carcinomatodes). Arch Gynäkol 50:287–321CrossRefGoogle Scholar
  2. 2.
    Schlagenhaufer F (1902) Ueber das metastatische ovarial-carcinom nach Krebs des Magens, Darmes, und anderer Bauchorgane. Monatschr F Geburtsh U Gynäckol 1:485–528Google Scholar
  3. 3.
    Wang J, Shi YK, Wu LY et al (2008) Prognostic factors for ovarian metastases from primary gastric cancer. Int J Gynecol Cancer 18:825–832CrossRefPubMedGoogle Scholar
  4. 4.
    Kim HK, Heo DS, Bang YJ, Kim NK (2001) Prognostic factors of Krukenberg’s tumor. Gynecol Oncol 82:105–109CrossRefPubMedGoogle Scholar
  5. 5.
    Man M, Cazacu M, Oniu T (2007) Krukenberg tumors of gastric origin versus Krukenberg tumors of colorectal origin. Chirurgia (Bucur) 102(4):407–410Google Scholar
  6. 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):157–158CrossRefPubMedGoogle Scholar
  7. 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):277–299PubMedGoogle Scholar
  8. 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):331–333PubMedGoogle Scholar
  9. 9.
    Novak E, Gray LA (1938) Krukenberg tumors of the ovary. Clinical and pathological study of 21 cases. Surg Gynecol Obstet 66:157–167Google Scholar
  10. 10.
    Cheong JH, Hyung WJ, Chen J et al (2004) Survival benefit of metastasectomy for Krukenberg tumors from gastric cancer. Gynecol Oncol 94:477–482CrossRefPubMedGoogle Scholar
  11. 11.
    Cheong J, Hyung WJ, Chen J et al (2004) Surgical management and outcome of metachronous Krukenberg tumors from gastric cancer. J Surg Oncol 87:39–45CrossRefPubMedGoogle Scholar
  12. 12.
    Japanese Gastric Cancer Association (1998) Japanese classification of gastric carcinoma, 2nd English edition. Gastric Cancer 1:10–24CrossRefPubMedGoogle Scholar
  13. 13.
    Sobin LH, Wittekind C, Gospodarowicz M (eds) (2009) TNM classification of malignant tumors (UICC), 7th edn. Wiley, New York, pp 73–77Google Scholar
  14. 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):2005–2011PubMedGoogle Scholar
  15. 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):97–101CrossRefPubMedGoogle Scholar
  16. 16.
    Yoo CH, Noh SH, Shin DW et al (2000) Recurrence following curative resection for gastric carcinoma. Br J Surg 87:236–242CrossRefPubMedGoogle Scholar
  17. 17.
    Kim NK, Kim HK, Park BJ et al (1999) Risk factors for ovarian metastasis following curative resection of gastric adenocarcinoma. Cancer 85:1490–1499CrossRefPubMedGoogle Scholar
  18. 18.
    Al-Agha OM, Nicastri AD (2006) An in-depth look at Krukenberg tumor: an overview. Arch Pathol Lab Med 130(11):1725–1730PubMedGoogle Scholar
  19. 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 32:3397–3401PubMedGoogle Scholar
  20. 20.
    Mrad K, Morice P, Fabre A et al (2000) Krukenberg tumor: a clinico-pathological study of 15 cases. Ann Pathol 20:202–206PubMedGoogle Scholar
  21. 21.
    Savey L, Lasser P, Castaigne D et al (1996) Krukenberg tumors. Analysis of a series of 28 cases. J Chir (Paris) 133:427–431Google Scholar
  22. 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 148:353–360CrossRefPubMedGoogle Scholar
  23. 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. 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 7:1310–1317PubMedGoogle Scholar
  25. 25.
    Di Giorgio A, Pinto E (eds) (2015) Treatment of peritoneal surface malignancies. State of the art and perspectives. Springer-Verlag XVI, BerlinGoogle Scholar
  26. 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 34:1246–1252Google Scholar

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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