.jpg "Taylor Neilson, MD photo")
Taylor Neilson, MD
Surgical Oncology T32 Research Fellow
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston TX, USA.
Houston, Texas, United States
Jason A. Willis, MD PhD
Assistant Professor
Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center
Houston, Texas, United States
Stephanie S. Keeling, MD
T32 Research Fellow
University of Texas MD Anderson Cancer Center
Houston, Texas, United States
LaDonna Kearse, MD
Fellow
University of Texas MD Anderson Cancer Center
Houston, Texas, United States
Kilian Brown, MBBS, MPhil
Fellow
University of Texas MD Anderson Cancer Center
Houston, Texas, United States
Megan Delisle, MD, MPH
Fellow
University of Texas MD Anderson Cancer Center
Houston, Texas, United States
Kentaro Ochiai, MD, PhD
Postdoctoral Fellow
University of Texas MD Anderson Cancer Center
Houston, Texas, United States
Beth A. Helmink, MD, PhD (she/her/hers)
Assistant Professor
Department of Surgical Oncology, University of Texas MD Anderson Cancer Center
Houston, Texas, United States
Yun Song, MD (she/her/hers)
Assistant Professor
Department of Surgical Oncology, University of Texas MD Anderson Cancer Center
Houston, Texas, United States
Y. Nancy You, MD, MHSc
Professor
University of Texas MD Anderson Cancer Center
Houston, Texas, United States
Brian K. Bednarski, MD (he/him/his)
Associate Professor
MD Anderson Cancer Center
Houston, Texas, United States
Tsuyoshi Konishi, MD, PhD
Associate Professor
University of Texas MD Anderson Cancer Center
Houston, Texas, United States
Ramy Behman, MD, PhD
Assistant Professor
University of Texas MD Anderson Cancer Center
Houston, Texas, United States
Jenny Moon, MD, MSc
Assistant Professor
University of Texas MD Anderson Cancer Center
Houston, Texas, United States
Craig A. Messick, MD
Associate Professor
University of Texas MD Anderson Cancer Center
Houston, Texas, United States
Montserrat Guraieb-Trueba, MD
Assistant Professor
University of Texas MD Anderson Cancer Center
Houston, Texas, United States
Jagan Ramamurthy, MD
Fellow
University of Texas MD Anderson Cancer Center
Houston, Texas, United States
Miguel Rodriguez-Bigas, MD
Professor
University of Texas MD Anderson Cancer Center
Houston, Texas, United States
George J. Chang, MD, MSc, MHCM
Professor
University of Texas MD Anderson Cancer Center
Houston, Texas, United States
J. Joshua Smith, MD, PhD
Professor and Chair
Department of Colon & Rectal Surgery, University of Texas MD Anderson Cancer Center
Houston, Texas, United States
Paul F. Mansfield, MD
Professor
Department of Surgical Oncology, University of Texas MD Anderson Cancer Center
Houston, Texas, United States
Keith F. Fournier, MD
Associate Professor
Department of Surgical Oncology, University of Texas MD Anderson Cancer Center
Houston, Texas, United States
.jpg "Michael G. White, MD, MS photo")
Michael G. White, MD, MS
Assistant Professor, Director of Research
Department of Colon and Rectal Surgery, University of Texas MD Anderson Cancer Center
Houston, Texas, United States
Paula Marincola Marincola Smith, MD, PhD
Assistant Professor of Surgery
Department of Colon & Rectal Surgery, University of Texas MD Anderson Cancer Center
Houston, Texas, United States
Ryan B. Morgan, MD
Fellow
MD Anderson Cancer Center
Houston, Texas, United States
In patients with colorectal cancer (CRC)-related carcinomatosis, ovarian metastases are common and are often resistant to systemic chemotherapy. As a result, many surgeons advocate bilateral oophorectomy during cytoreductive surgery (CRS), even in the absence of gross abnormalities. Defining this risk of metastasis is critical for counseling patients on the necessity of routine oophorectomy during CRS.
Methods: We performed a retrospective analysis of female patients with CRC-related carcinomatosis undergoing curative intent CRS with or without Hyperthermic Intraperitoneal Chemotherapy (HIPEC) at a single high-volume tertiary referral center from 2008-2024. Descriptive statistics were used to summarize patient demographics, the presence of ovarian metastases, and clinical outcomes.
Results:
Seventy-four patients were identified over the study period. Patients were majority white (n = 62, 84%) and non-Hispanic (58, 78%) with a median age of 49 [IQR 40-57]. Forty-nine (66%) were post-menopausal at the time of CRS. Patients had a median peritoneal cancer index (PCI) of 7.5 [IQR 4-9.25], and all patients had a complete cytoreduction (CCR 0/1). Right-sided primary tumors were most common (58%), and histology was most commonly non-mucinous (51, 69%), moderately or poorly differentiated (72, 97%), and microsatellite stable (67, 96%). Neoadjuvant therapy was common (58, 78%), and 25 (34%) patients underwent HIPEC. Four patients (5%) had undergone bilateral salpingo-oophorectomy (BSO) prior to the diagnosis of peritoneal disease. Of the 70 remaining patients with at least one ovary in situ at the time of carcinomatosis diagnosis, 51 (73%) had grossly abnormal appearing ovaries. Sixty-five (93%) had a completion- or bilateral-salpingo-oophorectomy, and 2 (3%) had one ovary left in situ. Overall, 55 (79%) had pathologically confirmed ovarian metastases. Of the 16 patients with grossly normal appearing ovaries who underwent oophorectomy, 4 (25%) had microscopic ovarian metastasis. Two of the 5 patients (40%) who had at least one normal-appearing ovary left in situ during CRS experienced ovarian recurrence within 16 months.
Conclusions:
Most female patients undergoing CRS for CRC-related carcinomatosis were found to have ovarian metastases on final pathology, including 25% of patients with grossly normal appearing ovaries. Short-interval recurrence was observed with ovarian preservation. Routine BSO should be strongly considered in patients undergoing CRS with curative intent.