title: Synchronous hepatic metastasis and metachronous Krukenberg tumor from advanced colon cancer. A case report with an unexpected disease-free survival.
abstract: BACKGROUND
  In the international literature we have never found a long survival in patients treated for a colon cancer with synchronous hepatic metastases and for a metachronous Krukenberg tumor.
  
  
  METHODS
  A 46-year old woman for an advanced colon cancer with a synchronous hepatic metastases was subjected to a left hemicolectomy and a resection of liver segment V (R0 resection; T4N2bM1; stage IVa according AJCC 2010). After one year a CT of the abdomen revealed an expansive formation of the left ovary. The patient was subjected to a bilateral ovariectomy, hysterectomy and hiperthermic intraperitoneal chemotherapy (HIPEC). The patient, after several cycles of adjuvant chemotherapy, is disease-free 13 years after surgery.
  
  
  CONCLUSIONS
  To our knowledge, in the literature there do not appear to be cases of such disease-free survival. The survival of patient despite the prognostic indexes is discussed. The authors discus the importance of an adequate surgical treatment especially for liver metastases simultaneously treated to colon cancer. The authors also focus on chemotherapy (FOLFOX and then FOLFIRI) performed in a pre-biological era. Furthermore, the degree to which the HIPEC may have had an impact is still unknown, although it seems to be the gold standard for the treatment of the microscopic peritoneal neoplastic remnant.
  
  
  CONCLUSIONS
  The authors emphasize that the long term survival in colon cancer with hepatic and ovarian metastases is possible as long as it has an adequate surgical approach, a tailored chemotherapy and an intensive follow-up. Most likely new prognostic markers will have to be identified.
authors.affiliation: University of Catania, Department of "Medical and Surgical Sciences and Advanced Technology G.F. Ingrassia"- Via Santa Sofia 86, 95123 Catania Italy. Electronic address: g.lidestri@unict.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Li Destri
authors.affiliation: University of Catania, Department of "Medical and Surgical Sciences and Advanced Technology G.F. Ingrassia"- Via Santa Sofia 86, 95123 Catania Italy. Electronic address: lipuzzo@unict.it.
authors.forename: Lidia
authors.initials: L
authors.lastname: Puzzo
authors.affiliation: St. Vincent Hospital, Division of Medical Oncology, Contrada Sirina, 98039 Taormina, Messina, Italy. Electronic address: alessierikarusso@hotmail.it.
authors.forename: Alessia Erika
authors.initials: AE
authors.lastname: Russo
authors.affiliation: St. Vincent Hospital, Division of Medical Oncology, Contrada Sirina, 98039 Taormina, Messina, Italy. Electronic address: ferrau@oncologiataormina.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Ferraù
authors.affiliation: University of Catania, Department of "Medical and Surgical Sciences and Advanced Technology G.F. Ingrassia"- Via Santa Sofia 86, 95123 Catania Italy. Electronic address: dicataldoa@tiscali.it.
authors.forename: Antonio
authors.initials: A
authors.lastname: Di Cataldo
authors.affiliation: University of Catania, Department of "Medical and Surgical Sciences and Advanced Technology G.F. Ingrassia"- Via Santa Sofia 86, 95123 Catania Italy. Electronic address: spuleo@unict.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Puleo
keywords: Advanced colorectal cancer; Case report; Disease free survival; Hepatic metastasis; Krukenberg tumor; Prognostic indexes