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Is Total Omentectomy Mandatory in T3 and T4a Gastric Cancer for Laparoscopic Distal Gastrectomy?

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Despite the lack of strong evidence, total omentectomy (TO) remains the recommended procedure for gastric cancer (GC) for T3 or deeper tumors. Partial omentectomy (PO) has recently become a preferred procedure owing to its simplicity during laparoscopic distal gastrectomy (LDG); however, the oncological role of PO needs to be elucidated.

Methods

Overall, 341 patients with T3 or T4a GC who had undergone LDG between 2009 and 2016 were divided into TO (n = 167) and PO (n = 174) groups. Propensity matching was performed with respect to covariance age, sex, T and N stage, tumor size, and degree of tumor differentiation. Clinicopathological characteristics and long-term follow-up data were analyzed for both groups.

Results

After successful propensity matching, both groups included 107 patients. In a matched cohort, no significant difference in clinicopathologic features and short-term surgical outcomes was observed between the two groups. Furthermore, no significant difference in relapse-free survival (RFS; p = 0.201) and peritoneal seeding-free survival (PSFS; p = 0.094) was observed. However, tumor recurrence as peritoneal metastasis occurred in 5 (4.7%) patients in the PO group and 13 (12.1%) patients in the TO group. In Cox proportional hazards analysis, omentectomy was not identified as a significant factor for RFS, PSFS, and overall survival; however, advanced N and T4a stage were considered significant factors for RFS and PSFS, respectively.

Conclusions

PO may be adopted during the LDG of T3 or T4a GC without definite gross serosal exposure. More large-scale evidence or prospective study is recommended.

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Acknowledgment

None.

Funding

This study was partly supported by the Clinical Trials Center of Eunpyeong St. Mary’s Hospital, The Catholic University of Korea. The manuscript and its data have not been previously published in any form.

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Authors and Affiliations

  1. Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

    Hayemin Lee MD, PhD, Dong Jin Kim MD, PhD, Han Hong Lee MD, PhD, Junhyun Lee MD, PhD, Kyung Hwa Jun MD, PhD, Kyo Young Song MD, PhD, Hyung Min Chin MD, PhD, Jin Jo Kim MD, PhD & Wook Kim MD, PhD

  2. Department of Surgery, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

    Dong Jin Kim MD, PhD

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  1. Hayemin Lee MD, PhD
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  2. Dong Jin Kim MD, PhD
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  5. Kyung Hwa Jun MD, PhD
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Corresponding author

Correspondence to Dong Jin Kim MD, PhD.

Ethics declarations

Hayemin Lee, Dong Jin Kim, Han Hong Lee, Junhyun Lee, Kyung Hwa Jun, Kyo Young Song, Hyung Min Chin, Jin Jo Kim, and Wook Kim have no related conflicts of interest to declare.

Ethical Approval

Data collection and analysis were approved by the IRB of the Catholic University of Korea, and the requirement for informed consent was waived (IRB approval number: XC20REDI0023). All procedures performed in the studies involving human participants were in accordance with the ethical standards of our IRB, along with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Although further studies are recommended, partial omentectomy may be adopted during the laparoscopic distal gastrectomy of T3 or T4a gastric cancer without definite gross serosal exposure.

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Lee, H., Kim, D.J., Lee, H.H. et al. Is Total Omentectomy Mandatory in T3 and T4a Gastric Cancer for Laparoscopic Distal Gastrectomy?. Ann Surg Oncol 30, 289–297 (2023). https://doi.org/10.1245/s10434-022-12386-3

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  • DOI: https://doi.org/10.1245/s10434-022-12386-3

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