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PPS16. Risk of Ovarian Metastasis in Colorectal Cancer-Related Carcinomatosis

Thursday, March 5, 2026
10:00 AM - 10:30 AM MST
Location: HUB Poster Park - West Hall 1-3

    Poster Presenter(s)

  • Ryan B. Morgan, MD

    Fellow
    MD Anderson Cancer Center
    Houston, Texas, United States

    • Co-Author(s)

  • 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

  • JW

    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

  • LK

    LaDonna Kearse, MD

    Fellow
    University of Texas MD Anderson Cancer Center
    Houston, Texas, United States

  • KB

    Kilian Brown, MBBS, MPhil

    Fellow
    University of Texas MD Anderson Cancer Center
    Houston, Texas, United States

  • MD

    Megan Delisle, MD, MPH

    Fellow
    University of Texas MD Anderson Cancer Center
    Houston, Texas, United States

  • KO

    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

  • YY

    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

  • JM

    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

  • MR

    Miguel Rodriguez-Bigas, MD

    Professor
    University of Texas MD Anderson Cancer Center
    Houston, Texas, United States

  • GC

    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

  • PM

    Paul F. Mansfield, MD

    Professor
    Department of Surgical Oncology, University of Texas MD Anderson Cancer Center
    Houston, Texas, United States

  • KF

    Keith F. Fournier, MD

    Associate Professor
    Department of Surgical Oncology, University of Texas MD Anderson Cancer Center
    Houston, Texas, United States

  • 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

Introduction:  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.

Learning Objectives:

  • Evaluate the incidence of ovarian metastases in patients undergoing cytoreductive surgery for colorectal cancer-related carcinomatosis.
  • Assess the risk of occult metastases in patients with grossly normal-appearing ovaries in the setting of peritoneal carcinomatosis.