Comparative Study of Complete and Partial Omentectomy in Radical Subtotal Gastrectomy for Early Gastric Cancer

Abstract

PurposeCurative surgery for patients with advanced or even early gastric cancer can be defined as resection of the stomach and dissection of the first and second level lymph nodes, including the greater omentum. The aim of this study was to evaluate the short- and long- term outcomes of partial omentectomy (PO) as compared with complete omentectomy (CO).Materials and MethodsSeventeen consecutive open distal gastrectomies with POs were initially performed between February and July in 2006. The patients' clinicopathologic data and post-operative outcomes were retrospectively compared with 20 patients who underwent open distal gastrectomies with COs for early gastric cancer in 2005.ResultsThe operation time in PO group was significantly shorter than that in CO group (142.4 minutes vs. 165.0 minutes, p=0.018). The serum albumin concentration on the first post-operative day in PO group was significantly higher than CO group (3.8 g/dL vs. 3.5 g/dL, p=0.018). Three postoperative minor complications were successfully managed with conservative treatment. Median follow-up period between PO and CO was 38.1 and 37.7 months. All patients were alive without recurrence until December 30, 2009.ConclusionPO during open radical distal gastrectomy can be considered a more useful procedure than CO for treating early gastric cancer. To document the long-term technical and oncologic safety of this procedure, a large-scale prospective randomized trial will be needed.

Role of omentectomy as part of radical surgery for gastric cancer

“…According to the latest Japanese guideline complete omentectomy is advised for tumours with a clinical category of cT3 or above, but for cT1–T2 tumours the omentum more than 3 cm away from the gastroepiploic arcade may be preserved. No randomized clinical trials support omentectomy or omentum preservation during gastric cancer surgery. One trial in Japan is recruiting to evaluate the impact of omentectomy in gastric cancer surgery and to confirm the non‐inferiority of omentum‐preserving gastrectomy compared with conventional omentectomy in terms of survival.…”

“…Traditionally, complete omentectomy is performed in patients with gastric cancer as part of radical (sub)total gastrectomy with modified D2 lymphadenectomy. Complete resection of the greater omentum has been considered essential to ensure the elimination of micrometastases during surgery for advanced gastric cancer. However, the impact of complete omentectomy is considerable.…”

“…However, the impact of complete omentectomy is considerable. The procedure increases the operating time (especially for laparoscopic procedures), and is associated with greater blood loss and a higher risk of complications such as abdominal abscesses, ascites, anastomotic leakage, ileus, wound infections, and colonic and mesocolonic injuries. Patients are more vulnerable to peritoneal infections, which often have a more severe clinical course.…”

CT Findings of Benign Omental Lesions Following Abdominal Cancer Surgery

“…Therefore, the greater omentum, historically, was totally resected during surgery for abdominal cancer. However, several studies of omentum-preserving operations show a lower rate of postoperative complications and no statistically significant difference in patient survival, as compared with total omentectomy (5)(6)(7). Therefore, the use of omentum-preserving operations has recently been increasing, especially for gastric cancer surgery.…”

O papel da omentectomia na cirurgia do câncer gástrico

“…A remoção completa do grande omento tem sido considerada essencial para garantir a eliminação de micrometástases durante a cirurgia radical do CG. 68,69,79 Conquanto, não há consenso quanto ao valor oncológico da omentectomia no tratamento cirúrgico do CG entres as diretrizes Europeia, Americana e Japonesa. A diretriz Europeia não fornece nenhuma orientação sobre este assunto 101,102 , ao passo que a diretriz Americana recomenda a ressecção do grande e pequeno omento.…”