Total Omentectomy in Gastric Cancer Surgery: Is It Always Necessary?

Barchi, Leandro Cardoso; Ramos, Marcus Fernando Kodama Pertille; Dias, André Roncon; Yagi, Osmar Kenji; Ribeiro-Júnior, Ulysses; Zilberstein, Bruno; Cecconello, Ivan

doi:10.1590/0102-672020180001e1425

Cited by 18 publications

(12 citation statements)

References 32 publications

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“…Additionally, in our cohort, the presence of lymph node metastasis was not a factor associated with survival, which reinforces that restricted lymphadenectomy is appropriate in these patients. In our opinion, omentectomy may also be neglected in these patients 3 .…”

Section: Discussionmentioning

confidence: 86%

Gastrectomy in Octogenarians With Gastric Cancer: Is It Feasible?

Silva

Pereira

Ramos

et al. 2020

ABCD, arq. bras. cir. dig.

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Background: The octogenarian population is expanding worldwide and demand for gastrectomy due to gastric cancer in this population is expected to grow. However, the outcomes of surgery with curative intent in this age group are poorly reported and it is unclear what matters most to survival: age, clinical status, disease´s stage, or the extent of the surgery performed. Aim: Evaluate the results of gastrectomy in octogenarians with gastric cancer and to verify the factors related to survival. Methods: From prospective database, patients aged 80 years or older with histologically confirmed adenocarcinoma who had undergone gastrectomy with curative intent were selected. Factors related to postoperative complications and survival were studied. Results: Fifty-one patients fulfilled the inclusion criteria. A total of 70.5% received subtotal gastrectomy and in 72.5% D1 lymphadenectomy was performed. Twenty-five (49%) had complications, in eleven major complications occurred (seven of these were clinical complications). Hospital length of stay was longer (8.5 vs. 17.8 days, p=0.002), and overall survival shorter (median of 1.4 vs. 20.5 months, p=0.009) for those with complications. D2 lymphadenectomy and the presence of postoperative complications were independent factors for worse overall survival. Conclusion: Octogenarians undergoing gastrectomy with curative intent have high risk for postoperative clinical complications. D1 lymphadenectomy should be the standard of care in these patients.

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Section: Discussionmentioning

confidence: 86%

Gastrectomy in Octogenarians With Gastric Cancer: Is It Feasible?

Silva

Pereira

Ramos

et al. 2020

ABCD, arq. bras. cir. dig.

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“…Therefore, omentectomy should be the standard gastrectomy for patients with gastric cancer [ 5 ]. Meanwhile, other studies found that metastases in the greater omentum occurred in only 1.6% of GC patients who underwent gastrectomy [ 3 , 28 ]. These were correlated significantly with non-radical features and advanced disease, indicating stage IV disease and a poor prognosis [ 11 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

Efficiency of complete omentectomy in patients with resectable gastric cancer: a meta‑analysis and systematic review

et al. 2021

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Background We performed a meta-analysis to investigate the efficacy of complete omentectomy (CO) in patients undergoing radical gastrectomy for gastric cancer. Methods We conducted a literature search in PubMed, Web of Science, and the Cochrane Library databases for clinical research that compared CO with non-complete omentectomy (NCO). These articles were published prior to April 2021. Overall survival (OS) rates, relapse-free survival (RFS) rates, recurrence rates, operation times, estimates of blood loss, numbers of harvested lymph nodes, complications, and lengths of hospital stays were compared using relative risks (RRs) and weighted mean differences (WMDs). RevMan 5.3 software was used for statistical analysis. Results Nine studies that included 3329 patients (1960 in the CO group) and 1369 in the NCO group comprised the analysis. The meta-analysis showed that CO was associated with a decreased 3-year OS rate (RR = 0.94, 95% CI 0.90–0.98, P = 0.005) and 5-year OS rate (RR = 0.93, 95% CI 0.88–0.98, P = 0.007). However, it was not associated with the 3-year RFS rate (RR = 0.97, 95% CI 0.90–1.04, P = 0.44), 5-year RFS (RR = 0.98, 95% CI 0.90–1.06, P = 0.60), or recurrence rate (RR = 1.17, 95% CI 0.95–1.45, P = 0.15) compared to the NCO group. For surgical-related outcomes, significant heterogeneity existed between the studies. Compared to the NCO group, CO was found to be associated with significantly more estimated blood loss (WMD = 250.90, 95% CI 105.90–396.28, P = 0.0007) and less harvested lymph nodes (WMD = − 3.59, 95% CI − 6.88, − 0.29, P = 0.03). Although, there was no significant difference in the surgical time (WMD = 15.93, 95% CI − 0.21, 32.07, P = 0.05). No statistically significant differences were observed in the rates of overall (P = 0.79) and major complications (P = 0.90), or the lengths of hospital stays (P = 0.11) between the two groups. Conclusions Based on the available evidence, CO is not superior to NCO in terms of survival. CO is not recommended as a routine surgery for gastric cancer. Future well-designed high-quality RCTs are warranted.

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“…D2/modified D2 dissection is performed as a standard procedure in patients with stomach cancer. Barchi et al [ 14 ] in their series of 284 patients who underwent omentectomy, D2 dissection, and gastrectomy due to stomach cancer, found omental metastasis in only five patients (1.8%). They determined that omental metastasis prevalence was higher in patients who had T3-T4 lesions.…”

Section: Discussionmentioning

confidence: 99%

Is omentectomy necessary in the treatment of benign or malignant abdominal pathologies? A systematic review

Atay¹,

Dılek²

2021

WJGS

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BACKGROUND The omentum is an organ that is easily sacrificed during abdominal surgery. The scope of omentectomy and whether a routine omentectomy should be performed are still unknown. AIM To review the literature in order to determine the physiological functions of the omentum and the roles it plays in pathological events in order to reveal the necessity for removal and preservation of the omentum. METHODS A clinical review of the English language literature based on the MEDLINE (PubMed) database was conducted using the keywords: “abdomen”, “gastrointestinal”, “tumor”, “inflammation”, “omental flap”, “metastasis”, “omentum”, and “omentectomy”. In addition, reports were also identified by systematically reviewing all references in retrieved papers. RESULTS The omentum functions as a natural barrier in areas where pathological processes occur in the abdominal cavity. The omentum limits and controls inflammatory and infectious pathologies that occur in the abdomen. It also aids in treatment due to its cellular functions including lymphatic drainage and phagocytosis. It shows similar behavior in tumors, but it cannot cope with increasing tumor burden. The stage of the disease changes due to the tumor mass it tries to control. Therefore, it is considered an indicator of poor prognosis. Due to this feature, the omentum is one of the first organs to be sacrificed during surgical procedures. However, there are many unknowns regarding the role and efficacy of the omentum in cancer. CONCLUSION The omentum is a unique organ that limits and controls inflammatory processes, foreign masses, and lesions that develop in the abdominal cavity. Omental flaps can be used in all anatomical areas, including the thorax, abdomen, pelvis, and extremities. The omentum is an organ that deserves the title of the abdominal policeman. It is generally accepted that the omentum should be removed in cases where there is tumor invasion. However, the positive or negative contribution of omental resection in the treatment of abdominal pathologies should be questioned.

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Total Omentectomy in Gastric Cancer Surgery: Is It Always Necessary?

Cited by 18 publications

References 32 publications

Gastrectomy in Octogenarians With Gastric Cancer: Is It Feasible?

Gastrectomy in Octogenarians With Gastric Cancer: Is It Feasible?

Efficiency of complete omentectomy in patients with resectable gastric cancer: a meta‑analysis and systematic review

Is omentectomy necessary in the treatment of benign or malignant abdominal pathologies? A systematic review

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