Cytoreductive Surgery for Intestinal Cancer Patients Metastatic to Ovaries Presenting as Primary Ovarian Cancer

Abstract

Colorectal cancer accounts for one third of non-genital tumors metastasize to the ovaries. We aimed to investigate the role of cytoreductive surgery in colon and small intestinal cancer patients with adnexal metastases, which were operated as primary epithelial ovarian cancer. This analysis included 26 patients with adnexal metastasis from colon and distal ileum, patients presented as primary ovarian cancer cases and were operated upon in Zekai Tahir Burak Women's Health Hospital, Gynecologic Oncology Unit between 2008 and 2014. Patients with history of intestinal cancers were not included in the study. The median age of patients was 54 (range= 26-77). Among all patients, 63% were premenopausal and 37% were postmenopausal. Most common presenting symptom was abdominal distention (80%). Optimal cytoreduction was performed in 21 patients. Right hemicolon was the primary site of tumor in 8 patients, while recto-sigmoid and appendiceal tumors were present in 7 and 7 patients, respectively. Isolated ovarian metastases were found in 6 patients, the remaining 20 patients had peritoneal carcinomatosis. Median follow-up was 25 months (ranging 3-59). In total, 11 patients died, of them, two patients had isolated ovarian metastasis, while the remaining nine patients had peritoneal carcinomatosis. Estimated median overall survival was 36.8 months (95% CI= 28.6-45.1 months). Median overall survival of patients who underwent cytoreductive surgery was not reached (36.8+ months), compared with 18.3 (95% CI= 0.0-46.4) months for patients with suboptimal cytoreductive surgery (p= 0.008). This retrospective study showed that cytoreductive surgery might have beneficial effect in selected patients with intestinal cancer metastatic to the adnexal.