SYNCHRONOUS SURGICAL REMOVAL OF SUSPICIOUS OVARIAN METASTASES FROM COLORECTAL CANCER

Metastatic ovarian cancers occur in 3-8 percent of women undergoing surgical resection of a primary colorectal cancer. In this study we examined the characteristics of women with colorectal cancer for whom synchronous oophorectomy had been performed. In this cross-sectional study, records of patients with colorectal cancer from April 1991 through October 1999 who had undergone surgery for both colorectal cancer resection and oophorectomy for suspicious ovarian metastasis in the Cancer Institute, Imam Khomeini Medical Center, were reviewed. SPSS version 10 was used for statistical analysis. The studied cases (n= 82) comprised 44.1 percent of all recorded cases of women with colorectal cancer during this period (N= 186). The mean age of our cases was 52.19 years. 54.9% of the studied women were in stage C of colorectal cancer. The commonest pathology of tumors was adenocarcinoma (89%). Well differentiated carcinoma was observed in 43.9%, followed by moderately differentiated carcinoma in 37.8%, poorly differentiated in 12.2% and unspecified in 6.1 %. 22 of our patients (26.8%) had gross abnormalities of ovaries at operation. In 13 cases (15.8% of our 82 studied cases and 6.99% of all 186 women with colorectal cancer), tumoral involvement of ovaries was proven through pathologic examination. 10 out of these 13 cases were among those with gross abnormalities of ovaries at operation (p= 0.048). Among the 13 patients with ovarian metastasis, 11 cases (84.6%) were in stage C at operation (p= 0.02) and 7 (53.8%) had well differentiated carcinoma (p= 0.04). Patients with ovarian metastases of colorectal origin are generally peri- or post menopausal. Like similar studies, in our setting, about 7 percent of all recorded female cases with colorectal cancer turned out to have ovarian metastases in surgical pathologic examination. In fact, 15.8% of our 82 cases sustaining surgery for "colorectal cancer and suspicious ovarian metastasis" proved to have ovarian metastasis. We recommend that prophylactic oophorectomy be performed in postmenopausal women with advanced stage colorectal cancer or any other woman with colorectal cancer with gross abnormality of the ovaries at operation.