[Krukenberg tumors. Analysis of a series of 28 cases]

We report a retrospective series of 28 patients with Krukenberg tumors treated at the Gustave Roussy Institute from 1973 to 1990. Mean age of these women was 42 years. The patients were classed into two groups: depending on whether the ovarian metastasis (group 1) or the primary cancer (group 2) was discovered first. The primary tumor was identified in 20 cases (18 cases of linitis, 1 tumor of the cecum, 1 tumor of the appendix). The primary tumor remained unknown in 8 cases. Twenty-seven patients underwent radical total hysterectomy or bilateral adnexectomy. Gastrectomy was possible for 11 of the 18 cases of linitis; hemicolectomy and appendectomy were performed for the cecal and appendicular tumors respectively. Diagnosis of a primary tumor of the appendix was made after systematic appendectomy and of two Krukenberg tumors after systematic bilateral adnexectomy. In the first group of patients, both localizations were treated in 6 cases, one in 12 including 4 because gastrectomy was not initially possible and in 8 because the primary tumor was unknown. In the second group, the two localizations were treated in 7 cases, and one in 2 cases because gastrectomy was not possible. Surgery was not performed in one patient due to diffuse carcinosis. Bilateral ovarian metastases were seen in 26 out of the 28 cases and 26/28 had chemotherapy without any appreciable effect. Bone metastasis predominated (9 cases), followed by pleuropulmonary (5 cases) and liver (3 cases) metastasis. Overall median survival was 20 months; 14 months in the first group and 29 months in the second. Appendectomy and exploration of the colon and the stomach were performed in all cases in which the Krukenberg tumor was discovered intraoperatively. An endosonographic exploration of the stomach is recommended if the primary tumor is not localized. Bilateral adnexectomy should always be performed in patients with linitis whatever the age. Surgical treatment of the two localizations is not always sufficient for cure.