GYNECOLOGIC ONCOLOGY 66, 41–44 (1997) ARTICLE NO. GO974720 Metastatic Breast Carcinoma to the Abdomen and Pelvis 1 Nadeem R. Abu-Rustum, M.D.,* Carol A. Aghajanian, M.D.,² Ennapadam S. Venkatraman, Ph.D.,‡ Fariha Feroz, M.D.,* and Richard R. Barakat, M.D.* *Division of Gynecology, Department of Surgery, ² Division of Developmental Chemotherapy, Solid Tumor Service, and ‡Department of Epidemiology and Biostatistics, Memorial Sloan – Kettering Cancer Center, New York, New York 10021 Received December 31, 1996 survival lasting years and decades even after metastases, and Objective. The role of surgical resection of metastatic breast marked heterogeneity among patients [2]. Autopsy series cancer to the abdomen and pelvis is controversial. The objective have demonstrated that metastases from breast cancer can of this study is to describe the characteristics, surgical manage- occur in a variety of sites with lymph nodes, bone, lung, ment, and outcome of women with a history of breast adenocarci- and liver being the most commonly involved sites [3]. Sev- noma who developed abdominal or pelvic metastases during fol- eral authors have reported on metastatic tumors to the ovaries low-up. [4–8]; however, most series that specifically address meta- Methods. We retrospectively reviewed the medical records of 40 static breast carcinoma describe incidental ovarian metasta- female patients with documented invasive breast cancer who were sis found at autopsy or therapeutic oophorectomy [5, 9]. referred to the Gynecology Service between 1986 and 1995 and Because of the clinical similarity to adnexal cancers, it is were found to have metachronous abdominal and/orpelvic metas- not uncommon for the gynecologic oncologist to explore a tases. Results. The median patient age at exploration by the Gynecol- patient with a history of breast cancer and find metastatic ogy Service was 53.5 years (range 27–79 years), and the median mammary cancer in the abdomen and/or pelvis, a condition interval from breast cancer diagnosis to exploration was 80 months for which no clear guidelines are available regarding the role (range 9–264 months). The majority of patients, 32 (80%), had a of surgical resection or tumor debulking. The objective of preoperative diagnosis of a new pelvic mass or suspected abdomi- this review is to describe the characteristics, surgical man- nal carcinomatosis. With a median follow-up of 14.2 months fol- agement, and outcome of women with a history of breast lowing the diagnosis of abdominal or pelvic metastasis, the median adenocarcinoma who were operated on by the Gynecology survival for all patients was 24.1 months. Patients who had no Service and were found to have metastatic mammary carci- gross residual disease in the abdomen or pelvis after surgery had noma to the abdomen or pelvis. a median survival of 41.6 months, which did not significantly differ from those with gross residual £2 cm (16.1 months) or ú2 cm (18.4 months) (P Å 0.624). MATERIALS AND METHODS Conclusion. Metachronous abdominal and pelvic metastases from breast cancer may appear many years following initial diag- Utilizing the Virginia K. Pierce Gynecology Service Data- nosis and are often operated on by gynecologists because of their base, a comprehensive database of all patients treated by the clinical presentation. Surgical resection may be indicated in some Gynecology Service at Memorial Sloan – Kettering Cancer symptomatic patients;however, the survival advantage of surgical cytoreduction remains to be determined.  1997 Academic Press Center, we identified all patients with a final diagnosis of metastatic breast cancer who were operated on by the Gyne- cology Service between 1986 and 1995 and were found to INTRODUCTION have metastatic mammary carcinoma to the abdomen and/ or pelvis. Breast cancer remains the most common malignancy in Individual medical records were then retrospectively re- women in the United States, with an increasing trend in both viewed and patient characteristics, indications for operation, incidence and early detection [1]. Breast cancers may be type of surgery, diameter of residual disease, salvage ther- among the more slowly growing solid tumors with a natural apy, and outcome were recorded. The length of follow-up history occasionally characterized by long disease duration, was determined from the patients last available medical re- cord. Survival probability data were computed using the Kaplan – Meier method, and differences in survival between 1 Supported in part by The Avon Ovarian Cancer Program and NIH Grant PO1-CA52477. patient groups were calculated using the log-rank test. 41 0090-8258/97 $25.00 Copyright  1997 by Academic Press All rights of reproduction in any form reserved.