The primary aim of the present retrospective study was to evaluate the feasibility and efficacy of laparoscopic prophylactic oophorectomy plus N3 lymph node dissection for patients with rectosigmoid cancer. The secondary aim was to explore the clinicopathologic features of ovarian micrometastasis from rectosigmoid cancer.
We performed 244 laparoscopic resections of rectosigmoid cancer in women during a 6-year period. In them, 34 patients (13.9%) were subjected to prophylactic oophorectomy plus N3 lymphadenectomy in addition to the standard anterior or low anterior resection of rectosigmoid cancer, because the patients presented with ovarian cystic lesions, tethering of the ovary to the primary rectosigmoid tumor, and/or pelvic ascites accumulation, which were postulated as the indicative findings for the synchronous ovarian micrometastasis. The surgical procedures are detailed in the attached video. The surgical outcomes were compared between patients with (n = 34) and without (n = 210) these two additional procedures. In analyzing the clinicopathologic features of ovarian micrometastasis, we included both cases of laparoscopic (n = 34) and traditional open surgery (n = 30), whose prophylactic oophorectomy was performed by the same surgical indications.
Although the operation time was significantly longer (264.2 ± 24.5 vs. 192.5 ± 24.2 minutes, P < .0001) in patients with prophylactic oophorectomy and N3 lymphadenectomy, there was no significant difference between patients with and without the two additional procedures in blood loss, wound length, postoperative complications, diverting ileostomy, and mortality. Although flatus passage, hospitalization, postoperative pain, and return to partial activity were statistically different between the study groups, they were deemed clinically unimportant because the difference of mean was very small. Foley removal was delayed in patients with N3 lymphadenectomy by 2 days. With respect to surgical efficacy, we found that patients undergoing the two additional procedures could collect significantly more lymph nodes (22.0 ± 4.0 vs. 14.4 ± 2.4, P < .0001) for pathologic staging and facilitated upstaging of nodal status in three patients (8.8%). Patients undergoing prophylactic oophorectomy plus N3 lymphadenectomy could achieve good oncologic outcome, with the estimated 5-year survival rate of 62.5% and 69.2% in patients with and without ovarian micrometastasis, respectively. Clinicopathologically, patients with ovarian micrometastasis (n = 15) tended to have vascular invasion of tumor cells, as compared with those without (n = 49). However, ovarian micrometastasis was not related to menstrual status of patients, tumor location, tumor size, morphology, differentiation, mucin production, T stage, nodal invasion, and level of carcinoembryonic antigen.
Laparoscopic surgical techniques could be safely applied to perform prophylactic oophorectomy plus N3 lymphadenectomy with acceptable efficacy in a highly selected subset of patients with rectosigmoid cancer.
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Graffner HO, Alm PO, Oscarson JE. Prophylactic oophorectomy in colorectal carcinoma. Am J Surg 1983;146:233–5
MacKeigan JM, Ferguson JA. Prophylactic oophorectomy and colorectal cancer in premenopausal patients. Dis Colon Rectum 1979;22:401–5
Becker SO, Tomacruz R, Kaufman HS, Bristow RE, Montz FJ. Gynecologic abnormalities in surgically treated women with stage II or III rectal cancer. J Am Coll Surg 2002;194:315–23
Schofield A, Pitt J, Biring G, Dawson PM. Oophorectomy in primary colorectal cancer. Ann R Coll Surg Engl 2001;83:81–4
Sakakura C, Hagiwara A, Kato D, Hamada T, Yamagishi H. Manifestation of bilateral huge ovarian metastases from colon cancer immediately after the initial operation: report of a case. Surg Today 2002;32:371–5
Köves I, Vamosi-Nagy I, Besznyak I. Ovarian metastases of colorectal tumours. Eur J Surg Oncol 1993;19:633–5
Miller BE, Pittman B, Wan JY, Fleming M. Colon cancer with metastasis to the ovary at time of initial diagnosis. Gynecol Oncol 1997;66:368–71
Cutait R, Lesser ML, Enker WE. Prophylactic oophorectomy in surgery for large-bowel cancer. Dis Colon Rectum 1983;26:6–11
Ballantyne GH, Reigel MM, Wolff BG, Ilstrup DM. Oophorectomy and colon cancer. Impact on survival. Ann Surg 1985;202:209–14
Young-Fadok TM, Wolff BG, Nivatvongs S, Metzger PP, Ilstrup DM. Prophylactic oophorectomy in colorectal carcinoma: preliminary results of a randomized, prospective trial. Dis Colon Rectum 1998;41:277–83
Pistorius SR, Nagel M, Kruger S, et al. Combined molecular and clinical approach for decision making for surgery in HNPCC patients: a report on three cases in two families. Int J Colorectal Dis 2001;16:402–7
Liang JT, Huang KC, Cheng AL, Jeng YM, Wu MS, Wang SM. Clinicopathological and molecular biological features of colorectal cancer in patients less than 40 years of age. Br J Surg 2003;90:205–14
Reardon CM, Kavanagh EG, Sabah M, Kirwan WO. Ovarian cancer mimicking recurrence at colorectal anastomosis: report of a case. Dis Colon Rectum 1998;41:1312–4
Scholefield JH, Steup WH. Surgery for rectal cancer in Japan. Lancet 1992;340:1101
Japanese Society for Cancer of the Colon and Rectum. General Rules for Clinical and Pathological Studies on Cancer of the Colon, Rectum, and Anus. Tokyo: Kanehara, 1994
Liang JT, Lai HS, Lee PH. Laparoscopic total mesorectal excision for rectal cancers. Dis Colon Rectum 2006;49:517–8
Liang JT, Shieh MJ, Chen CN, Cheng YM, Chang KJ, Wang SM. Prospective evaluation of laparoscopy-assisted colectomy versus laparotomy with resection in the management of complex polyps of the sigmoid colon. World J Surg 2002;26:377–83
Shin EK, Takizawa BT, Masters L, Shahabi S. The role of chemotherapy and prophylactic bilateral oophorectomy in a case of colorectal adenocarcinoma with ovarian metastases. Yale J Biol Med 2001;74:101–5
de Gramont A, Figer A, Seymour M, et al. Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer. J Clin Oncol 2000;18:2938–47
Lewis MR, Deavers MT, Silva EG, Malpica A. Ovarian involvement by metastatic colorectal adenocarcinoma: still a diagnostic challenge. Am J Surg Pathol 2006;30:177–84
Kiyokawa T, Young RH, Scully RE. Krukenberg tumors of the ovary: a clinicopathologic analysis of 120 cases with emphasis on their variable pathologic manifestations. Am J Surg Pathol 2006;30:277–99
Deddish MR. Surgical procedures for carcinoma of the left colon and rectum, with five-year end results following abdominopelvic dissection of lymph nodes. Am J Surg 1960;99:188–91
Quan SH, Sehdev MK. Pelvic surgery concomitant with bowel resection for carcinoma. Surg Clin North Am 1974;54:881–6
Sielezneff I, Salle E, Antoine K, Thirion X, Brunet C, Sastre B. Simultaneous bilateral oophorectomy does not improve prognosis of postmenopausal women undergoing colorectal resection for cancer. Dis Colon Rectum 1997;40:1299–302
Taylor AE, Nicolson VM, Cunningham D. Ovarian metastases from primary gastrointestinal malignancies: the Royal Marsden Hospital experience and implications for adjuvant treatment. Br J Cancer 1995;71:92–6
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Liang, J., Lai, H., Wu, C. et al. Laparoscopic Prophylactic Oophorectomy Plus N3 Lymphadenectomy for Advanced Rectosigmoid Cancer. Ann Surg Oncol 14, 1991–1999 (2007). https://doi.org/10.1245/s10434-007-9346-3
- Laparoscopic surgery
- Prophylactic oophorectomy
- N3 lymphadenectomy