P12: Krukenberg tumours from a colorectal origin – the diagnosis, management, timelines and outcomes in a single Australian tertiary centre

Krukenberg tumours, aggressive metastatic ovarian tumour originating from non-gynaecological sources, remain a challenge for clinicians. The management of those with  colorectal origins lacks well-defined guidelines, leading to variations in management and outcomes. We describe the management of Krukenberg tumours from a colorectal origin within a major Australian tertiary centre.



Methods:

This retrospective study identified Krukenberg tumours of colorectal origin within a single tertiary referral centre (Western Health) in Melbourne, Australia. Data were extracted from a prospective Australian Comprehensive Cancer Outcomes and Research Database (ACCORD) as well as MDT and Hospital Electronic Medical Records.



Results:

The clinical trajectories of twenty-one patients (mean age 56.9 years, range 34 – 87) between 2005 and 2023 were identified. The majority of these patients initially consulted general surgeons or gastroenterologists (n=18, 86%), while a smaller fraction sought initial care from gynaecologist oncologists (n=3, 14%). In most cases, Krukenberg tumours presented synchronously with the diagnosis of their primary colorectal tumour (n=18, 86%,). Majority presented with colonic primaries (n=19, 90%), with the remaining cases originating from the rectum (n=2, 10%). The majority of patients (n=16, 76%) underwent primary elective surgical resection (n=11, 69%). The average time between diagnosis and surgery was 39 days (range 0 – 168 days). Amongst those who received surgical management, a notable proportion required a stoma (n=7, 44%), and cytoreductive surgery was attempted in some cases (n=6, 40%). Approximately two-thirds of patients underwent adjuvant chemotherapy (n=14, 66%). The mean length of survival was approximately 19 months (from diagnosis). A noteworthy observation revealed that patients unable to undergo surgical intervention, as well as those afflicted with bilateral ovarian involvement, demonstrated less favourable outcomes and survival durations.



Conclusions:

Krukenberg tumours from colorectal origins are aggressive malignancies that predominantly afflict younger individuals, with an average survival less than two years. Given the late presentation of this disease, a high degree of clinical suspicion and timely investigations are imperative for early intervention and improved patient outcomes.