Bilateral ovarian micrometastatic adenocarcinoma upon prophylactic oophorectomy concurrent with low anterior resection for rectal cancer

Abstract

BackgroundThis case report draws attention to the debated role of prophylactic oophorectomy in women undergoing definitive surgical resection of colon and rectal cancers. It can be challenging to discern the indications and appropriate patient population for this procedure based on the current literature. Potential benefits include treatment and prevention of metastatic disease, preventing development of primary ovarian cancer, and prolonging survival. Negative effects include an increase in operative time and potential morbidity, development of osteoporosis, the risk of cardiac events, and decreasing sexual function. Multiple patient factors such as age, menopausal status, patient preference, presence of hereditary conditions, exposure to radiation, site, and stage of disease should be considered.Case presentationWe present a case in which a premenopausal 49-year-old female underwent a prophylactic bilateral salpingo-oophorectomy concurrently with a low anterior resection following neoadjuvant chemoradiation for clinical stage III rectal cancer. On pathologic examination, resection margins and all 14 lymph nodes harvested were negative for malignancy. Interestingly, she was found to have micrometastatic adenocarcinoma in the bilateral ovaries which had appeared grossly normal at the time of surgery.ConclusionsAfter consideration of the current literature, patient preference, and our clinical judgment, our patient ultimately had a therapeutic effect after undergoing prophylactic bilateral oophorectomy concurrently with a low anterior resection for rectal cancer. The addition of prophylactic oophorectomy in a select population, specifically women 50 years of age or younger and/or women who are in the premenopausal state, may carry a survival benefit in the setting of definitive surgical resection of colon and rectal cancers.

To investigate the mechanism of Yiwei Decoction in the treatment of premature ovarian insufficiency-related osteoporosis using transcriptomics, network pharmacology and molecular docking techniques

“…As a result, POI may result in an earlier onset of osteoporosis 23 . Furthermore, loss of ovarian function due to ovarian removal or cancer chemotherapy can result in the onset of osteoporosis at a young age 24 .…”

Ovarian metastases in young women with colorectal cancer: a retrospective multicenter cohort study

“…Furthermore, it has been reported that ovary removal in women below the age of 45 appears to have an increased mortality risk compared to those above this age [57]. Many negative consequences can, however, largely be prevented by the use of hormone replacement therapy (HRT), which is advised in these specific situations [58][59][60].…”

Metastatic Ovariectomy is Beneficial for Survival in Ovarian Metastasis of Colorectal Carcinoma: A Single-center Experience in China

“…However, current studies are insu cient to identify with this hypothesis. Robin Irons and colleagues reported a retrospective case showing that prophylactic oophorectomy have possible bene ts from rendering them free of suffering metsatasis [17]. Liu et al showed that CRC patients with prophylactic ovariectomy combined with N3 lymph node dissection have good oncological results [18].…”