title: Krukenberg Tumors of Gastric Origin: The Rationale of Surgical Resection and Perioperative Treatments in a Multicenter Western Experience.
abstract: BACKGROUND
  In case of Krukenberg tumor (KT) of gastric origin it is controversial and debated whether radical surgery in case of synchronous KT or metastasectomy in case of metachronous ones is associated with additional benefits. Role of perioperative treatments is unclear.
  
  
  METHODS
  Among 2515 female patients who were diagnosed with gastric cancer between January 1990 and December 2012 from 9 Italian centers, 63 presented simultaneously or developed KT as recurrence.
  
  
  RESULTS
  Thirty patients presented with synchronous KT, while 33 developed metachronous ovarian metastases during follow-up. The differences between the two groups were analyzed and compared. The median age of 63 patients was 48.0 years (range 31-71). Resection was possible in 53 patients (20 synchronous and 33 metachronous). Twelve patients in the synchronous group and 15 patients of the metachronous group underwent hyperthermic intraperitoneal chemotherapy after resection of KT. All of them underwent adjuvant chemotherapy after KT resection. The median survival for all population was 23 months (95 % confidence interval, 7-39 months). The median survival time in the metachronous group was 36 months, which was significantly longer than that in the synchronous group, 17 months, p < 0.0001.
  
  
  CONCLUSIONS
  KT remains a clinical challenge for gastric cancer therapy. The extent of disease and feasibility of removal of the metastatic lesion must be carefully evaluated prior to surgery to define the patients group who could benefit most from a resection associated with perioperative treatments.
authors.affiliation: Department of Digestive Surgery, Catholic University of Rome, Rome, Italy. faust.rosa@tiscali.it.|Department of Digestive Surgery, Catholic University - "A. Gemelli" Hospital, Largo A. Gemelli, 8, 00168, Rome, Italy. faust.rosa@tiscali.it.
authors.forename: Fausto
authors.initials: F
authors.lastname: Rosa
authors.affiliation: Institute of Surgical Sciences, University of Siena, Siena, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Marrelli
authors.affiliation: Division of Surgery, "G.B. Morgagni, L. Pierantoni" Hospital, Forlì, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Morgagni
authors.affiliation: 1st Division of Surgery, "Borgo Trento" Hospital, University of Verona, Verona, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Cipollari
authors.affiliation: Division of Surgery, "G.B. Morgagni, L. Pierantoni" Hospital, Forlì, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Vittimberga
authors.affiliation: Department of Surgery and Advanced Cancer Therapies, Morgagni-Pierantoni Hospital, Forlì, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Framarini
authors.affiliation: Division of Surgical Oncology, IRCCS Istituto Clinico Humanitas, Rozzano, Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Cozzaglio
authors.affiliation: General Surgery A, "Borgo Roma" Hospital, University of Verona, Verona, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Pedrazzani
authors.affiliation: Surgical Oncology, John Paul II Foundation, Campobasso, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Berardi
authors.affiliation: Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy.
authors.forename: Gian Luca
authors.initials: GL
authors.lastname: Baiocchi
authors.affiliation: Institute of Surgical Sciences, University of Siena, Siena, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Roviello
authors.affiliation: Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy.
authors.forename: Nazario
authors.initials: N
authors.lastname: Portolani
authors.affiliation: 1st Division of Surgery, "Borgo Trento" Hospital, University of Verona, Verona, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: de Manzoni
authors.affiliation: Department of Digestive Endoscopy, Catholic University of Rome, Rome, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Costamagna
authors.affiliation: Department of Digestive Surgery, Catholic University of Rome, Rome, Italy.
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Doglietto
authors.affiliation: Department of Digestive Surgery, Catholic University of Rome, Rome, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Pacelli
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D065426:Cytoreduction Surgical Procedures / Q000379:methods*; D005260:Female; D005743:Gastrectomy / Q000379:methods; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods*; D007263:Infusions, Parenteral; D007558:Italy; D053208:Kaplan-Meier Estimate; D007725:Krukenberg Tumor / Q000556:secondary / Q000628:therapy*; D059146:Metastasectomy; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000628:therapy*; D010051:Ovarian Neoplasms / Q000556:secondary / Q000628:therapy*; D010052:Ovariectomy / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D047368:Tumor Burden
chemical_list: D000970:Antineoplastic Agents