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

Abstract

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.

Prevention of Anastomotic Leak in Minimally Invasive Esophagectomy: The Role of Anastomotic Technique and Adjuvant Surgical Strategies

“…The omentum is an organ with widely described properties, including control of intra-abdominal infectious and inflammatory processes, angiogenesis, and wound healing promotion, as well as a key role in tumor spread, thus being characterized as "the abdominal policeman" [31]. It also holds a crucial role as a reconstructive tool, since omental flaps are commonly used for reinforcement of esophagogastric anastomosis after open or minimally invasive esophagectomy, taking advantage of its anatomical and physiological characteristics [10].…”

Análisis De Literatura Sobre El Tratamiento Contemporáneo Del Plastrón Apendicular.

“…Este proceso se caracteriza por la formación de una masa inflamatoria alrededor del apéndice inflamado, compuesta por tejido inflamado, vísceras adyacentes y epiplón mayor. El plastrón actúa como una barrera física que limita la propagación de la infección hacia la cavidad abdominal, evitando así la peritonitis generalizada (12).…”

Normal saline remodels the omentum and stimulates its receptivity for transcoelomic metastasis

“…Furthermore, there is a lack of consensus as to the amount of healthy omental tissue that should be removed in patients who present without overt metastasis. One school of thought has advocated omental biopsies rather than removal of the omentum in these cases, as omentectomy may have complications such as increasing the risk of sepsis, adhesive bowel obstruction, and splenic injury (10)(11)(12)(13)(14). In support of this line of thinking, a study using a rat model of ovarian cancer found that prophylactic omentectomy did not improve survival (15).…”

“…Our findings suggest that normal saline stimulates the receptivity of the omentum for cancer cells and that the risk of colonization can be minimized by using a biocompatible crystalloid for lavage procedures. JCI Insight 2023;8 (12):e167336 https://doi.org/10.1172/jci.insight.167336…”