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Life sciences · Journal article
JAMA Oncology · September 24, 2026
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Importance Colorectal cancer is the third most common and deadly cancer among women worldwide. Although ovarian metastases from colon cancer are relatively uncommon, they remain clinically significant due to their association with poor prognosis and the longstanding suspicion that the ovaries may function as a chemotherapy-resistant sanctuary site. This review examines the evidence for this phenomenon and potential role of surgical resection of metastatic disease. Observations Twenty-four retrospective studies comprising 2705 patients with ovarian metastases from colorectal cancer were evaluated. Ovarian metastases demonstrated lower objective chemotherapy response rates than extraovarian metastases, had substantially lower mean shrinkage, and frequently exhibited discordant growth during treatment. The most favorable outcomes associated with improved survival were observed in patients who had complete surgical resection of ovarian metastases and microscopically negative margins. Conclusions Collectively, the literature supports the ovary functioning as a relative sanctuary site in metastatic colorectal cancer, suggesting that systemic therapy alone should not be regarded as adequate. Instead, systemic therapy assumes a complementary role in reducing overall tumor burden and improving candidacy for resection. Therefore, optimal management should aim for clearance of all macroscopic disease, with negative surgical margins pursued when feasible. Metastasectomy should be performed within the context of comprehensive disease control, including resection of the primary tumor.