Efficacy of Omentum-Preserving Gastrectomy for Patients With Gastric Cancer: A Systematic Review and Meta-Analysis

Abstract

BackgroundComplete omentectomy is considered to be essential in the radical gastrectomy for gastric cancer (GC), but its clinical benefit remains unclear. This study aims to evaluate the efficacy of omentum-preserving gastrectomy (OPG) for patients with GC.MethodsStudies comparing the surgical and oncological outcomes of OPG and gastrectomy with complete omentectomy (GCO) for GC up to March 2021 were systematically searched from PubMed, Web of Science, Embase, and Cochrane Library. A pooled analysis was performed for the available data regarding the baseline features, surgical and oncological outcomes. The RevMan 5.3 software was used to perform the statistical analysis. Quality evaluation and publication bias were also conducted.ResultsNine studies with a total of 3335 patients (1372 in the OPG group and 1963 in the GCO group) undergoing gastrectomy were included. In the pooled analysis, the baseline data in two groups were all comparable (p > 0.05). However, the OPG group was associated with shorter operative time (MD = −18.67, 95% CI = −31.42 to −5.91, P = 0.004) and less intraoperative blood loss (MD = −38.09, 95% CI = −53.78 to −22.41, P < 0.00001) than the GCO group. However, the number of dissected lymph nodes (MD = 2.16, 95% CI = −0.61 to 4.93, P = 0.13), postoperative complications (OR = 0.92, 95% CI = 0.74 to 1.15, p = 0.47), overall recurrence rate (OR = 0.83, 95% CI = 0.66 to 1.06, p = 0.14), peritoneal recurrence rate (OR = 0.91, 95% CI = 0.65 to 1.29, p = 0.60), 3-year relapse-free survival (RFS) rate (OR = 1.40, 95% CI = 0.86 to 2.27, p = 0.18), and 5-year RFS rate (OR = 1.21, 95% CI = 0.95 to 1.55, p = 0.12) of the two groups were comparable.ConclusionsOPG might be an oncologically safe procedure with better surgical outcomes for patients with GC than GCO. However, high-quality randomized controlled trials are needed to confirm this benefit.

The outcomes of laparoscopic omentum-preserving gastrectomy compared to open surgery with omentectomy in gastric cancer patients: a propensity score matched study of 249 UICC stage 0–IV gastric cancer patients

“…In the multivariate analysis, only the UICC stage and age were determined to have significantly impacted survival in our patient group, while the complete omentectomy did not have any significant impact on the overall survival. Similar results were obtained by other retrospective studies [ 3 – 7 ]. These studies are prone to selection bias due to their retrospective nature.…”

“…The patients in LAP group had lower morbidity rates compared to OPN group. Complete omentectomy has been shown to be related to a higher incidence of complications [ 3 – 8 ]. Our results support these findings.…”

“…However, given that peritoneal dissemination is the most common type of recurrence after gastrectomy for gastric cancer, there is a substantial concern among surgeons that omentum preservation could potentially lead to more peritoneal recurrence. Furthermore, surgeons have feared that residual omentum after surgery could cause intestinal obstruction [ 3 , 8 ]. Therefore, this study aimed to evaluate the impact of laparoscopic gastrectomy with omentum preservation on perioperative complications, peritoneal recurrence, postoperative intestinal obstruction occurrence, and long-term survival compared to open gastrectomy with omentectomy.…”

Efficacy of indocyanine green fluorescence imaging-guided lymphadenectomy in radical gastrectomy for gastric cancer: A systematic review and meta-analysis

“…Gastric cancer (GC) is one of the most common cancers worldwide with more than one million new cases and 760,000 deaths in 2020 (1). At present, radical gastrectomy combined with D2 lymphadenectomy is still the most effective treatment for GC (2,3). The status of lymph nodes (LNs) is a stronger prognostic factor for the survival of GC patients and sufficient lymphadenectomy can improve the prognosis of GC patients (4)(5)(6).…”

Gastrectomy With Omentum Preservation vs Gastrectomy With Omentectomy for Locally Advanced Gastric Cancer : A Systematic Review

“…Nevertheless, the clinical benefit of GCO for GC remains unclear. 12,13 Removal of the omentum may cause problems. The omentum functions as a protective cushion, reducing intestinal adhesion and also preventing inflammation in adjacent sites.…”