Retroperitoneal dissemination of colorectal ovarian metastases: Basis for rationale use of lymphadenectomy.

Abstract

535 Background: Retroperitoneal lymph nodes are a common site of metastases in primary ovarian cancers and primary peritoneal carcinoma, therefore pelvic and paraaortic lymphadenectomy are recommended. Colorectal ovarian metastases are mostly associated to peritoneal carcionomatosis (PC), which treatment is based on complete cytoreductive surgery (CCRS) associated to intraperitoneal chemotherapy (IPC). The aim of this study was to compare the rate of nodal (pelvic, paraaortic) recurrences, between 2 groups of patients (pts) operated on PC with ovarian metastases (OM) or without OM. Methods: From January 1994 to December 2009, all consecutive women who underwent CCRS plus IPC, were selected from a prospective database. Demographics, tumor characteristics, surgical procedures and chemotherapy, were analyzed and compared. Results: One hundred and five pts were identified; 63 (60%) had ovarian metastasis (synchronous or metachronous). Groups were comparable for all variables, except for the median peritoneal cancer index which was lower in the OM group (9 vs.10.5, p<.05). Nodal recurrences were diagnosed in 19 pts (18%), in paraaortic nodes in 14 pts (74%), pelvic nodes in 7 pts (36%), both in 2 pts (10%) and were associated to other relapse in 15 pts (80%). All these nodal recurrences occurred in the OM group (30% vs. 0, p<.001). After a median follow-up of 74 months (10-196), 3-year overall survival rate was greater in pts without nodal recurrences (71 vs 41 %, p=0.37) and at the end of the study, there was significantly more patients died of disease in case of nodal recurrence (24/44 vs 5/19, p=.04). Conclusions: Nearly one third of patients with ovarian metastases experienced paraaortic and pelvic nodes recurrences. This may due to the specific pattern of lymphatic spread of ovary, well known in primary carcinomas. Therefore, systematic lymphadenectomy should be studied in patients with colorectal ovarian metastases treated in curative intent. No significant financial relationships to disclose.