Lack of Oncological Benefit from Bursectomy in Radical Gastrectomy: A Systematic Review

Abstract

<b><i>Background:</i></b> Resection of the omental bursa has been suggested to reduce peritoneal recurrence and facilitate a complete oncological resection during a gastrectomy. The addition of this procedure increases technical complexity and prolongs the procedure. Published data regarding the oncological benefit of this procedure are conflicting. We hypothesized that a bursectomy during a radical gastrectomy does not improve overall survival. <b><i>Methods:</i></b> In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline, a comprehensive literature search of 3 electronic databases (PubMed, Scopus, and Embase) was conducted to identify the clinical studies that compared bursectomy with no-bursectomy in radical gastrectomy for gastric adenocarcinoma. Qualitative and quantitative data synthesis was performed using RevMan software. A random-/fixed-effect modeling was used depending upon the heterogeneity. Bias and quality assessment tools were applied. The study was registered with the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42019116556). <b><i>Results:</i></b> Of 8 studies assessing the role of bursectomy in gastric adenocarcinoma, 6 (75%) were included – of which 2 (33%) are randomized controlled trials. Of 2,904 patients, 1,273 (%) underwent a bursectomy. There was no statistically significant difference in either overall survival (hazard ratio [HR] = 0.89, 95% CI 0.75–1.06, <i>I</i><sup>2</sup> = 14%) or disease recurrence (HR = 1.01, 95% CI 0.84–1.20, <i>I</i><sup>2</sup> = 22%) in the bursectomy group compared to the no-bursectomy group. <b><i>Conclusion:</i></b> There is no additional oncological benefit of adding bursectomy to radical gastrectomy in all patients with gastric adenocarcinoma.

Editorial: Multimodal management of advanced gastric cancer

“…As per the GLOBOCAN 2020 data, Gastric cancer is the fifth most common cancer and is the fourth major cause of cancer related death worldwide ( 1 ). The sheer magnitude of the gastric cancer cases has compelled the researchers across the globe to perform extensive research to demystify its etiopathogenesis to management strategies.…”