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

• Published in: World journal of surgery Vol. 40; no. 4; pp. 921 - 928
• Main Authors: Rosa, Fausto, Marrelli, Daniele, Morgagni, Paolo, Cipollari, Chiara, Vittimberga, Giovanni, Framarini, Massimo, Cozzaglio, Luca, Pedrazzani, Corrado, Berardi, Stefano, Baiocchi, Gian Luca, Roviello, Franco, Portolani, Nazario, de Manzoni, Giovanni, Costamagna, Guido, Doglietto, Giovanni Battista, Pacelli, Fabio
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-04-2016; Springer Nature B.V
• Subjects: Abdominal Surgery; Adult; Aged; Antineoplastic Agents - therapeutic use; Cardiac Surgery; Cytoreduction Surgical Procedures - methods; Female; Gastrectomy - methods; Gastric Cancer; General Surgery; Humans; Hyperthermia, Induced - methods; Infusions, Parenteral; Italy; Kaplan-Meier Estimate; Krukenberg Tumor - secondary; Krukenberg Tumor - therapy; Medicine; Medicine & Public Health; Metastasectomy; Middle Aged; Multivariate Analysis; Neoplasm Recurrence, Local - therapy; Original Scientific Report; Ovarian Metastasis; Ovarian Neoplasms - secondary; Ovarian Neoplasms - therapy; Ovariectomy - methods; Peritoneal Carcinomatosis; Peritoneal Recurrence; Prognosis; Retrospective Studies; Stomach Neoplasms - pathology; Stomach Neoplasms - surgery; Surgery; Survival Rate; Systemic Compute Tomography; Thoracic Surgery; Tumor Burden; Vascular Surgery; Gastric Cancer; Systemic Compute Tomography; Ovarian Metastasis; Peritoneal Recurrence; Peritoneal Carcinomatosis
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-015-3326-8

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.