Abstract
We will discuss here the role of splenectomy, bursectomy and omentectomy in the light of recent literature, taking as a starting point the indications reported by the most important guidelines: those from the Italian Research Group for Gastric Cancer (2015) and from the Japanese Gastric Cancer Association (2018). Splenectomy is indicated in cases of advanced gastric cancer with infiltration of the spleen or the pancreas. Despite the fact that 8–28% of proximal third gastric cancers metastasize to the splenic hilum nodes, the role of splenectomy as a facilitator of station 10 clearance is controversial and should be considered on condition that it can be conducted safely. Bursectomy is no longer supported as a technique increasing surgical cure rates. Still, it may have a role in selected patients candidate to non-standard multimodal management of stage IV gastric cancer. Omentectomy has always been part of curative gastrectomy in order to ensure control of micrometastases. However, the recent literature discusses this role and consensus regarding its real benefit seems lost.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
de Manzoni G, Marrelli D, Baiocchi GL, et al. The Italian Research Group for Gastric Cancer (GIRCG) guidelines for gastric cancer staging and treatment: 2015. Gastric Cancer. 2017;20(1):20–30.
Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer. 2021;24(1):1–21.
Sano T, Sasako M, Mizusawa J, et al. Randomized controlled trial to evaluate splenectomy in total gastrectomy for proximal gastric carcinoma. Ann Surg. 2017;265(2):277–83.
Yura M, Yoshikawa T, Otsuki S, et al. The therapeutic survival benefit of splenic hilar nodal dissection for advanced proximal gastric cancer invading the greater curvature. Ann Surg Oncol. 2019;26(3):829–35.
Okhura Y, Haruta S, Shindoh J, et al. Efficacy of prophylactic splenectomy for proximal advanced gastric cancer invading the greater curvature. World J Surg Oncol. 2017;15(1):106. https://doi.org/10.1186/s12957-017-1173-9.
Liu K, Chen XZ, Zhang YC, et al. The value of spleen-preserving lymphadenectomy in total gastrectomy for gastric and esophagogastric junctional adenocarcinomas: a long-term retrospective propensity score match study from a high-volume institution in China. Surgery. 2020;169(2):426–35.
Zheng CH, Xu YC, Zhao G, et al. Safety and feasibility of laparoscopic spleen-preserving No. 10 lymph node dissection for locally advanced upper third gastric cancer: a prospective, multicenter clinical trial. Surg Endosc. 2020;34(11):5062–73.
Perivoliotis K, Baloyiannis I, Symeonidis D, Tepetes K. The role of bursectomy in the surgical management of gastric cancer: a meta-analysis and systematic review. Updat Surg. 2020;72(4):939–50.
Hirao M, Kurokawa Y, Fujita J, et al. Long-term outcomes after prophylactic bursectomy in patients with resectable gastric cancer: final analysis of a multicenter randomized controlled trial. Surgery. 2015;157(6):1099–105.
Kurokawa Y, Doki Y, Mizusawa J, et al. Bursectomy versus omentectomy alone for resectable gastric cancer (JCOG1001): a phase 3, open-label, randomized controlled trial. Lancet Gastroenterol Hepatol. 2018;3(7):460–8.
Ministrini S, Bencivenga M, Solaini L, et al. Stage IV gastric cancer: the surgical perspective of the Italian Research Group on Gastric Cancer. Cancers (Basel). 2020;12(1):158. https://doi.org/10.3390/cancers12010158.
Jongerius EJ, Boerma D, Seldenrijk KA, et al. Role of omentectomy as part of radical surgery for gastric cancer. Br J Surg. 2016;103(11):1497–503.
Haverkamp L, Brenkman HJF, Ruurda JP, et al. The oncological value of omentectomy in gastrectomy for cancer. J Gastrointest Surg. 2016;20(5):885–90.
Ri M, Nunobe M, Akimoto E, et al. Gastrectomy with or without omentectomy for cT3-4 gastric cancer: a multicentre cohort study. Br J Surg. 2020;107(12):1640–7.
Kim DJ, Lee JH, Kim W. A comparison of total versus partial omentectomy for advanced gastric cancer in laparoscopic gastrectomy. World J Surg Oncol. 2014;12:64. https://doi.org/10.1186/1477-7819-12-64.
Sato Y, Yamada T, Yoshikawa T, et al. Randomized controlled phase III trial to evaluate omentum preserving gastrectomy for patients with advanced gastric cancer (JCOG1711, ROAD-GC). Jpn J Clin Oncol. 2020;50(11):1321–4.
Acknowledgments
Special thanks are extended to Marie Sophie Alfano, Ilenia Garosio, Beatrice Molteni for their contribution and support, in particular for investigation, bibliography resources, and review.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this chapter
Cite this chapter
Tiberio, G.A.M., Marano, L., Gelmini, R. (2022). Beyond Lymph Nodes: Splenectomy, Bursectomy and Omentectomy. In: de Manzoni, G., Roviello, F. (eds) Gastric Cancer: the 25-year R-Evolution. Updates in Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-73158-8_14
Download citation
DOI: https://doi.org/10.1007/978-3-030-73158-8_14
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-73157-1
Online ISBN: 978-3-030-73158-8
eBook Packages: MedicineMedicine (R0)