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

Abstract

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.

Korean Practice Guidelines for Gastric Cancer 2022: An Evidence-based, Multidisciplinary Approach

“…Seven previous meta-analyses studied the oncologic feasibility of PO [ 326 327 328 329 330 ]. All the meta-analyses showed that PO was not inferior to TO regarding OS and relapse-free survival.…”

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

“…It functions as a protective cushion and is responsible for peritoneal defenses. 1 Gastric cancer (GC) is the fourth most common cancer worldwide. In 2020, a total of 1,089,103 (5.6% of all cancer) new gastric cancer cases, causing 768,793 deaths (7.7% of all cancer), were estimated.…”

Gastrectomy with or without Complete Omentectomy for Advanced Gastric Cancer: A Meta-Analysis

“…Being the most common recurrence in GC, peritoneal metastases are estimated to occur in approximately 55-60% AGC patients, thus being deemed a leading factor in GC poor outcomes [5]. Peritoneal recurrence is commonly detected in patients undergoing gastrectomy for cT3 and cT4 GC [6,7]. As concerns metastatic peritoneal sites, the greater omentum is the most common metastatic area in AGC.…”

“…Several mainly retrospective observational studies analyzed the role of complete omentectomy (CO) in addition to radical gastrectomy in GC patients [16][17][18][19][20][21]. Given the presence of significant bias in the aforementioned studies, different meta-analyses have been developed in order to improve the present evidence [6,7,14,[22][23][24][25][26]. Such meta-analyses demonstrated that gastrectomy without CO gives similar, even better short-and longterm results than gastrectomy with CO, although many of those studies also included populations with early gastric cancer (EGC) [6,7,14,[22][23][24][25][26].…”

“…Given the presence of significant bias in the aforementioned studies, different meta-analyses have been developed in order to improve the present evidence [6,7,14,[22][23][24][25][26]. Such meta-analyses demonstrated that gastrectomy without CO gives similar, even better short-and longterm results than gastrectomy with CO, although many of those studies also included populations with early gastric cancer (EGC) [6,7,14,[22][23][24][25][26]. At present, outcomes of just one randomized controlled trial (RCT) are available [27], while two other RCTs are being investigated [28,29].…”