Partial Versus Total Omentectomy in Patients with Gastric Cancer: A Systemic Review and Meta-Analysis

Abstract

Background: Surgical treatment is the key to cure localized gastric cancer. There is no strong evidence that supports the value of omentectomy. Thus, a meta-analysis was conducted to compare the safety and efficiency of partial and total omentectomy in patients with gastric cancer. Methods: PubMed, Embase, and Cochrane Library databases were searched. All studies that compared total and partial omentectomy as treatments for gastric cancer were included. The primary outcomes were patients’ overall survival and disease-free survival, while the secondary outcomes were perioperative outcome and postoperative complications. Results: A total of nine studies were examined, wherein 1043 patients were included in the partial omentectomy group, and 1995 in the total omentectomy group. The partial omentectomy group was associated with better overall survival (hazard ratio: 0.80, 95% CI: 0.66 to 0.98, p = 0.04, I2 = 0%), shorter operative time, and lesser blood loss than the total omentectomy group. In addition, no statistically significant difference was observed in the number of dissected lymph nodes, length of hospital stays, complication rate, and disease-free survival. Conclusions: Our results show that, compared with total omentectomy in gastric cancer surgery, partial omentectomy had non-inferior oncological outcomes and comparable safety outcomes.

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

“…Likewise, although the omental lymph system was suggested as a bridge for metastasis to the peritoneal cavity in animal models, and omental lavage occasionally detect omental micrometastasis in patients with GC, there is still no evidence showing a definitive improvement of survival after gastrectomy with total omentectomy. 2,3 The advantage of complete omentectomy is in accordance with the current understanding of the lymphatic drainage of the omentum by means of milky spots, which are located throughout the entire greater omentum and act as a gate through the abdominal cavity into the subperitoneum, which contributes to the peritoneal seeding of cancer cells. Thus complete resection of the greater omentum has been believed to be essential to eliminate tumor cells during surgery for gastric cancer.…”

Caracterización de los desenlaces quirúrgicos a corto plazo en gastrectomía por laparoscopia en un centro de alto volumen: 10 años de experiencia

“…En los últimos años, los resultados de 3 metaanálisis han evidenciado no inferioridad de la omentectomía parcial versus total en cáncer gástrico. No obstante, en su mayoría los estudios incluidos dentro de estos metaanálisis son cohortes retrospectivas y se cuenta con muy pocos estudios aleatorizados [29][30][31] . Nuestro grupo realiza omentectomía de rutina, con un sangrado promedio de 213 ml, lo cual está en línea con la literatura mundial 32 .…”