Annals of Surgical Oncology

, Volume 20, Issue 2, pp 491–496 | Cite as

Ovarian Metastasis Is Associated with Retroperitoneal Lymph Node Relapses in Women Treated for Colorectal Peritoneal Carcinomatosis

  • Clarisse Eveno
  • Diane Goéré
  • Peggy Dartigues
  • Charles Honoré
  • Frédéric Dumont
  • Dimitri Tzanis
  • Léonor Benhaim
  • David Malka
  • Dominique Elias
Colorectal Cancer



To analyze the patterns of recurrence and the prognostic impact of ovarian metastases (OM) in a population of women with colorectal peritoneal carcinomatosis (CRPC) treated with curative intent.


Data from all consecutive women with CRPC who underwent curatively intended complete cytoreductive surgery (CRS) plus intraperitoneal chemotherapy at our institution were retrieved from a prospective database. A bilateral oophorectomy or a complementary unilateral oophorectomy was systematically performed during CRS.


From 1994 to 2009, among 105 women who underwent CRS plus intraperitoneal chemotherapy for CRPC, 62 (60 %) had OM. Women with and without OM had comparable peritoneal cancer index (PCI) scores (10 vs. 12, respectively, p = 0.09). After a median follow-up of 60 (range 5–145) months, median overall survival of women with OM did not differ statistically from that of women without OM (respectively, 36 and 40 months; p = 0.75). Relapses occurred in 82 % of the patients, distributed similarly between the two groups except for retroperitoneal lymph node recurrence, which occurred in 19 patients (18 %), including 18 with OM. The only predictive factor for a retroperitoneal relapse was a history of OM (p = 0.0012).


Retroperitoneal lymph node recurrence seems to be linked to OM originating from colorectal cancer and could worsen the prognosis. A systematic lymphadenectomy could be evaluated in women with isolated OM or very limited peritoneal carcinomatosis to analyze the incidence of invaded lymph nodes and study its potential benefit on survival.


Peritoneal Carcinomatosis Intraperitoneal Chemotherapy Peritoneal Cancer Index Retroperitoneal Lymph Node Positron Emission Tomographic 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors acknowledge Lorna Saint-Ange for her editing work.


  1. 1.
    Mahmoud N, Bullard Dunn K. Metastasectomy for stage IV colorectal cancer. Dis Colon Rectum. 2010;53:1080–92.PubMedCrossRefGoogle Scholar
  2. 2.
    Fujiwara A, Noura S, Ohue M, et al. Significance of the resection of ovarian metastasis from colorectal cancers. J Surg Oncol. 2010;102:582–7.PubMedCrossRefGoogle Scholar
  3. 3.
    Goere D, Daveau C, Elias D, et al. The differential response to chemotherapy of ovarian metastases from colorectal carcinoma. Eur J Surg Oncol. 2008;34:1335–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Lee SJ, Lee J, Lim HY, et al. Survival benefit from ovarian metastatectomy in colorectal cancer patients with ovarian metastasis: a retrospective analysis. Cancer Chemother Pharmacol. 2010;66:229–35.PubMedCrossRefGoogle Scholar
  5. 5.
    Segelman J, Floter-Radestad A, Hellborg H, Sjovall A, Martling A. Epidemiology and prognosis of ovarian metastases in colorectal cancer. Br J Surg. 2010;97:1704–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Evers DJ, Verwaal VJ. Indication for oophorectomy during cytoreduction for intraperitoneal metastatic spread of colorectal or appendiceal origin. Br J Surg. 2011;98:287–92.PubMedCrossRefGoogle Scholar
  7. 7.
    Glehen O, Kwiatkowski F, Sugarbaker PH, et al. Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis from colorectal cancer: a multi-institutional study. J Clin Oncol. 2004;22:3284–92.PubMedCrossRefGoogle Scholar
  8. 8.
    Glehen O, Mohamed F, Gilly FN. Peritoneal carcinomatosis from digestive tract cancer: new management by cytoreductive surgery and intraperitoneal chemohyperthermia. Lancet Oncol. 2004;5:219–28.PubMedCrossRefGoogle Scholar
  9. 9.
    Taylor AE, Nicolson VM, Cunningham D. Ovarian metastases from primary gastrointestinal malignancies: the Royal Marsden Hospital experience and implications for adjuvant treatment. Br J Cancer. 1995;71:92–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Jacquet P, Sugarbaker PH. Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. Cancer Treat Res. 1996;82:359–74.PubMedCrossRefGoogle Scholar
  11. 11.
    Choi PW, Kim HC, Kim AY, Jung SH, Yu CS, Kim JC. Extensive lymphadenectomy in colorectal cancer with isolated para-aortic lymph node metastasis below the level of renal vessels. J Surg Oncol. 2010;101:66–71.PubMedCrossRefGoogle Scholar
  12. 12.
    Min BS, Kim NK, Sohn SK, Cho CH, Lee KY, Baik SH. Isolated paraaortic lymph-node recurrence after the curative resection of colorectal carcinoma. J Surg Oncol. 2008;97:136–40.PubMedCrossRefGoogle Scholar
  13. 13.
    Nishioka K, Arai K, Iwasaki Y, et al. [Two patients with metastatic ovarian tumor (Krukenberg’s tumor) of gastric origin who underwent oophorectomy with paraaortic and intrapelvic lymph node dissection]. Gan To Kagaku Ryoho. 2003;30:1839–43.PubMedGoogle Scholar
  14. 14.
    Burghardt E, Girardi F, Lahousen M, Tamussino K, Stettner H. Patterns of pelvic and paraaortic lymph node involvement in ovarian cancer. Gynecol Oncol. 1991;40:103–6.PubMedCrossRefGoogle Scholar
  15. 15.
    Chen SS, Lee L. Incidence of para-aortic and pelvic lymph node metastases in epithelial carcinoma of the ovary. Gynecol Oncol. 1983;16:95–100.PubMedCrossRefGoogle Scholar
  16. 16.
    Onda T, Yoshikawa H, Yokota H, Yasugi T, Taketani Y. Assessment of metastases to aortic and pelvic lymph nodes in epithelial ovarian carcinoma. A proposal for essential sites for lymph node biopsy. Cancer. 1996;78:803–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Benedetti-Panici P, Greggi S, Maneschi F, et al. Anatomical and pathological study of retroperitoneal nodes in epithelial ovarian cancer. Gynecol Oncol. 1993;51:150–4.PubMedCrossRefGoogle Scholar
  18. 18.
    Morice P, Joulie F, Camatte S, et al. Lymph node involvement in epithelial ovarian cancer: analysis of 276 pelvic and paraaortic lymphadenectomies and surgical implications. J Am Coll Surg. 2003;197:198–205.PubMedCrossRefGoogle Scholar
  19. 19.
    Jaffre I, Bordes V, Dejode M, Dravet F, Classe JM. Management of retroperitoneal lymphadenectomy in advanced epithelial ovarian cancer. Bull Cancer. 2010;97:65–71.PubMedGoogle Scholar
  20. 20.
    Rouzier R, Bergzoll C, Brun JL, et al. The role of lymph node resection in ovarian cancer: analysis of the Surveillance, Epidemiology, and End Results (SEER) database. BJOG. 2010;117:1451–58.PubMedCrossRefGoogle Scholar
  21. 21.
    Elias D, Honore C, Dumont F, et al. Results of systematic second-look surgery plus HIPEC in asymptomatic patients presenting a high risk of developing colorectal peritoneal carcinomatosis. Ann Surg. 2011;254:289–93.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2012

Authors and Affiliations

  • Clarisse Eveno
    • 1
  • Diane Goéré
    • 1
  • Peggy Dartigues
    • 2
  • Charles Honoré
    • 1
  • Frédéric Dumont
    • 1
  • Dimitri Tzanis
    • 1
  • Léonor Benhaim
    • 1
  • David Malka
    • 3
  • Dominique Elias
    • 1
  1. 1.Department of Surgical OncologyInstitut Gustave RoussyVillejuif CedexFrance
  2. 2.Department of BiopathologyInstitut Gustave RoussyVillejuif CedexFrance
  3. 3.Department of Medical OncologyInstitut Gustave RoussyVillejuif CedexFrance

Personalised recommendations