Background: Routine oophorectomy in women with colorectal cancer is under debate, the aim of this study is to determine incidence, clinicopathologic features and prognostic factors of ovarian involvement in primary colorectal cancer (CRC) and to clear the role of prophylactic oophorectomy.
Methods: Data from primary CRC women treated between years 1990 and 2004 were retrieved and clinical and pathologic features of those who had undergone oophorectomy during CRC surgery were reviewed.
Results: One hundred eighty cases (mean age 47.5 years) were included. In 120(66.6%), ovaries were preserved and 60(33.3%) cases underwent bilateral oophorectomy in addition to primary CRC resection. Reasons for oophorectomy were prophylactic in 22(36.6%), abnormal morphology in 35(58.3%), and undetermined in 3(5%) cases. There were five metastatic carcinomas, eight primary ovarian tumors and 47 normal ovaries in pathologic evaluation. No complication directly related to oophorectomy was noted. Patients with ovarian metastases had higher stages of tumor. Ovarian metastases were not related to menstrual status, CRC location, size, differentiation, and mucin production, as well as abnormal morphology of ovary. The global prevalence of ovarian metastasis in CRC was 2.7%, and isolated ovarian metastases occurred in less than half of them. Of 120 women that underwent colectomy alone, eight (6.6%) developed ovarian metastasis during two years of follow-up. Only three cased had isolated ovarian metastases. No patient with synchronous or metachronous ovarian metastases from CRC survived five years.
Conclusion: Isolated ovarian metastases from primary CRC occur with a low frequency and this may partially explain the debate regarding prophylactic oophorectomy at the time of curative resection for primary CRC.