Is partial omentectomy feasible at radical gastrectomy for advanced cancer?

Aktaş, Aydın; Gündoğan, Ersin; Sümer, Fatih; Kayaalp, Cüneyt

doi:10.21037/tgh.2017.01.04

Transl. Gastroenterol. Hepatol.

2017

DOI: 10.21037/tgh.2017.01.04

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Is partial omentectomy feasible at radical gastrectomy for advanced cancer?

Aydın Aktaş

Ersin Gündoğan

Fatih Sümer

et al.

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Gastrectomy with omentum preservation versus gastrectomy with omentectomy for locally advanced gastric cancer: A systematic review and meta-analysis

Liao

et al. 2021

International Journal of Surgery

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Background Omentectomy has been traditionally a part of standard radical gastrectomy. Its clinical benefit for locally advanced gastric cancer (LAGC) remains controversial. This study aimed at evaluating the impact of gastrectomy with omentum preservation (GOP) on survival, recurrence, surgical outcomes and postoperative complications by comparing with gastrectomy with omentum resection (GOR). Methods Original studies comparing GOP with GOR in LAGC were searched. Meta-analysis was performed using RevMan 5.4. Results Seven studies involving 1879 patients were analyzed. Compared with GOR, GOP achieved significantly better overall survival (HR = 0.75 [0.60, 0.95], P = 0.01), with similar relapse-free survival (HR = 0.84 [0.68, 1.03], P = 0.10). The two groups had similar total recurrence rate (OR = 0.86 [0.68, 1.08], P = 0.19) and no significant differences in rates of peritoneal, hematogenous, locoregional or distant lymph node recurrences. GOP had significantly less blood loss (MD = −83 [-139, −28] ml, P = 0.003) and tended to have shorter operation time (MD = −28 [-58, 2] min, P = 0.06), with similar harvested number of lymph nodes (MD = −0.4 [-2.6, 1.8], P = 0.70). The incidences of total all grade and major complications were similar in GOP and GOR (all grade: 31.8% vs. 30.3%, OR = 1.08 [0.79, 1.46], P = 0.64; major: 9.2% vs. 10.1%, OR = 1.14 [0.55, 2.34], P = 0.73). There were no significant differences in incidences of complication or postoperative mortality. Conclusions Omentum preservation did not affect curability or survival in LAGC. These findings require validation in randomized controlled trials with large sample sizes. Graphical abstract Highlights

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Gastrectomy with omentum preservation versus gastrectomy with omentectomy for locally advanced gastric cancer: A systematic review and meta-analysis

Liao

et al. 2021

International Journal of Surgery

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Omental adipocytes promote peritoneal metastasis of gastric cancer through the CXCL2–VEGFA axis

et al. 2020

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Background Gastric cancer (GC) patients frequently develop peritoneal metastasis; however, the underlying mechanism remains unknown. We hypothesised that omental adipocytes (OmAd) trigger GC cells towards malignant activity to induce peritoneal metastasis. Methods We analysed interactions among human GC cells, endothelial cells and OmAd using a 3D co-culture system. We also employed a multipronged animal study, including subcutaneous and orthotopic tumours, and humanised omental adipose tissue models. Urinary levels of CXCL2 were analysed in human GC patients with and without peritoneal metastasis. Results Conditioned media derived from OmAd (OmAd-CM) promoted the proliferation, migration and capacity to induce angiogenesis of GC cells through AKT phosphorylation and VEGFA overexpression, whereas silencing CXCL2 in OmAd cancelled OmAd-induced effects. In an orthotopic tumour model using SCID mice, omentectomy suppressed GC growth and peritoneal dissemination, and reduced serum levels of CXCL2. OmAd promoted GC growth in a humanised omental adipose tissue model using NSG mice, but silencing CXCL2 in OmAd cancelled OmAd-induced tumour growth. Finally, urinary levels of CXCL2 were significantly higher in GC patients with peritoneal metastasis than in those without. Conclusion Omental adipocytes trigger GC cells to an aggressive phenotype through CXCL2 secretion, which induces angiogenesis followed by cell growth and peritoneal metastasis.

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Is partial omentectomy feasible at radical gastrectomy for advanced cancer?

Cited by 2 publications

References 4 publications

Gastrectomy with omentum preservation versus gastrectomy with omentectomy for locally advanced gastric cancer: A systematic review and meta-analysis

Gastrectomy with omentum preservation versus gastrectomy with omentectomy for locally advanced gastric cancer: A systematic review and meta-analysis

Omental adipocytes promote peritoneal metastasis of gastric cancer through the CXCL2–VEGFA axis

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