Clinical and pathological study of gastric cancer with ovarian metastasis.

Background: The aim of this study was to determine the treatment strategy for ovarian metastases from gastric cancer, by a retrospective study of the treatment results.

Methods: We reviewed the records of patients with ovarian metastases from primary gastric cancer. Ovarian metastases were found in 24 of 897 female patients with gastric cancer. Of these, 21 patients with histologically proven disease were studied.

Results: Ovarian metastasis was detected before the primary gastric cancer in 1 patient, simultaneously in 6, and after in 14. Ovarian tumors were detected by computed tomography (CT) in a majority of patients (95%), while uterine tumors were detected in only 29%. Metastasis to the uterus was histologically examined in 14 tumors and confirmed in 11 tumors. All patients with positive endometrial cytology had uterine metastases. Total abdominal hysterectomy was performed with bilateral salpingo-oophorectomy in 12 patients and with unilateral resection in 2. In these 14 patients, 5 were curatively operated. In the clinical course, all patients developed multiple metastases, and patients suffered peritoneal dissemination. None survived for longer than 3 years. The median survival time after ovarian metastases (MST) was 10.3 months for all patients; 3.6 months in patients in their sixties, and 12.5 months in those in their fifties. Survival was significantly longer in patients who underwent curative resection (MST, 30.4 months) compared with those who had noncurative resection (MST, 10.3 months).

Conclusion: The prognosis for ovarian metastasis of gastric cancer was poor without curative resection. Because of frequent microscopic metastases to the uterus, total hysterectomy with bilateral oophorectomy is recommended if curative resection is possible.