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Should total omentectomy be performed for advanced gastric cancer?: The role of omentectomy during laparoscopic gastrectomy for advanced gastric cancer

  • 2021 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

In the era of minimally invasive surgery, laparoscopic partial omentectomy (LPO) has seen widespread use as a curative surgical procedure for early gastric cancer. However, scientific evidence of the extent of omentectomy during laparoscopic gastrectomy remains unclear for advanced gastric cancer (AGC).

Methods

We analyzed 666 eligible patients who underwent laparoscopic gastrectomy for AGC with curative intent between 2014 and 2018. Surgical outcome and postoperative prognosis were compared between LPO and laparoscopic total omentectomy (LTO) groups after 2:1 propensity score matching with age, sex, body mass index, tumor size, pT stage, pN stage, gastrectomy type, and clinical T stage as covariates.

Results

After extensive matching, there was no significant difference in pathologic or clinical stages between the LPO (n = 254) and LTO (n = 177) groups. LPO provided a significantly shorter operation time than LTO (199.2 ± 64.8 vs. 248.1 ± 68.3 min, P < 0.001). Pulmonary complication within postoperative 30 days was significantly lower in the LPO group (4.4 vs. 10.3%, P = 0.018). In multivariate analysis, LTO was the independent risk factor for pulmonary complication (odds ratio [OR] 2.53, 95% confidence interval [95% CI] 1.12–5.73, P = 0.025), which became more obvious in patients with a Charlson’s comorbidity index of 4 or higher (OR 27.43, 95% CI 1.35–558.34, P = 0.031). The 5-year overall survival rate (OS) and 3-year recurrence-free survival (RFS) rates were not significantly different between the two groups, even after stage stratification.

Conclusion

LPO provided significantly shorter operation time and less pulmonary complication than LTO without compromising 5-year OS and 3-year RFS for AGC. LTO was the independent risk factor for pulmonary complications, which became more evident in patients with severe comorbidities.

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Funding

This work has supported by the National Research Foundation of Korea(NRF) grant funded by the Korea government(MSIT) (No. 2020R1C1C100922512). This research was supported by Research Program 2020 funded by Seoul National University College of Medicine Research Foundation (800-20200345).

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Authors and Affiliations

  1. Department of Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea

    Sangjun Lee, Yun-Suhk Suh, So Hyun Kang, Young Suk Park, Sang-Hoon Ahn & Hyung-Ho Kim

  2. Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea

    Yun-Suhk Suh, Young Suk Park, Sang-Hoon Ahn & Hyung-Ho Kim

  3. Department of Surgery, Seongnam Citizens Medical Center, Seongnam-si, South Korea

    Yongjoon Won

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  1. Sangjun Lee
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Correspondence to Yun-Suhk Suh.

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Sangjun Lee, MD, So Hyun Kang, MD, Yongjoon Won, MD, Young Suk Park, MD, Sang-Hoon Ahn, MD, and Hyung-Ho Kim, MD, PhD have no conflicts of interest or financial ties to disclose.

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Lee, S., Suh, YS., Kang, S.H. et al. Should total omentectomy be performed for advanced gastric cancer?: The role of omentectomy during laparoscopic gastrectomy for advanced gastric cancer. Surg Endosc 36, 6937–6948 (2022). https://doi.org/10.1007/s00464-022-09039-7

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  • DOI: https://doi.org/10.1007/s00464-022-09039-7

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