Krukenberg Tumors: Does Surgical Resection Improve Survival?

Krukenberg tumors are ovarian malignant tumors characterized by mucin-secreting signet ring cells. They represent 30% of malignant ovarian neoplasms where the stomach, colorectal, and breast are the most common primary sites. The optimal treatment modality is still controversial whether systemic therapy or surgical resection. This is a retrospective cohort study where all patients diagnosed with Krukenberg tumors who presented to a tertiary cancer center from July 2015 to August 2021 were included. Demographic, preoperative, operative, postoperative, pathologic, and oncologic follow-up data were analyzed aiming to assess the overall and disease-free survival of this cohort of patients and the possible role of surgery. Eighty-four patients were enrolled. The mean age was 43.5 years. Colorectal cancer was the commonest primary site in 52.4% followed by gastric and breast cancer. In 69% of patients, the Krukenberg presented primarily, and in 64.3% both ovaries were affected. The median overall survival was 20 (14.1-25.9) months. In multivariate analysis, primary cancer in the breast, resection of both primary and Krukenberg, and R0 resection have better overall survival with hazard ratio (0.31, 2.5, and 0.09 respectively). The median disease-free survival (for those post R0 resection) was 32 (4.4-59.6) months, while peritoneal/omental concomitant metastasis was the only significant predictor of shorter DFS. In conclusion, cytoreductive surgery offers longer overall survival, especially if R0 resection can be achieved. In addition, the patients without peritoneo-omental spread will have a longer disease-free survival after successful R0 resection.