KRUKENBERG TUMORS - 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 o f 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 identifi ed 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-s even patients underwent radical total hysterectomy or bilateral adnexe ctomy. Gastrectomy was possible for 11 of the 18 cases of linitis ; he micolectomy and appendectomy were performed for the cecal and appendic ular tumors respectively. diagnosis of a primary tumor of the appendix was made after systematic appendectomy and of two Krukenberg tumors a fter systematic bilateral adnexectomy. In the first group of patients, both localizations were treated in 6 cases, one in 12 including 4 bec ause gastrectomy was not initially possible and in 8 because the prima ry tumor was unknown. In the second group, the two localizations were treated in 7 cases, and one in 2 cases because gastrectomy was not pos sible. Surgery was not performed in one patient due to diffuse carcino sis. Bilateral ovarian metastases were seen in 26 out of the 28 cases and 26/28 had chemotherapy without any appreciable effect. Bone metast asis predominated (9 cases), followed by pleuropulmonary (5 cases) and liver (3 cases) metastasis. Overall median survival was 20 months ; 1 4 months in the first group and 29 months in the second. Appendectomy and exploration of the colon and the stomach were performed in all cas es in which the Krukenberg tumor was discovered intraoperatively. An e ndosonographic exploration of the stomach is recommended if the primar y tumor is not localized. Bilateral adnexectomy should always be perfo rmed in patients with linitis whatever the age. surgical treatment of the two localizations is not always sufficient for cure.