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Does total omentectomy prevent peritoneal seeding for advanced gastric cancer with serosal invasion?

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Abstract

Background

Radical gastrectomy is composed of gastrectomy, lymph node dissection, and omentectomy. Total omentectomy (TO) is expected to reduce the incidence of peritoneal recurrence. We aimed to investigate the necessity of TO for advanced gastric cancer (AGC) with serosal invasion.

Methods

We retrospectively reviewed 310 patients who underwent radical gastrectomy with TO and 93 patients who underwent partial omentectomy (PO) for gastric cancer with serosal invasion between August, 2005 and December, 2017. Finally, 91 patients in the PO group and 91 in the TO group were enrolled based on a 1:1 propensity-score matching analysis. We evaluated surgical and oncological outcomes, including 5-year overall and recurrence-free survival rates.

Results

There was no statistically significant difference between the two groups in postoperative complications. Recurrence sites showed similar patterns in both groups, including peritoneal recurrence (PO vs. TO, 18.7% vs. 28.6%; p = 0.188). Five-year overall survival was better in the PO group (p = 0.018), while 5-year recurrence-free survival was similar in both groups (p = 0.066).

Conclusion

TO might not be an essential part of preventing peritoneal recurrence for AGC with serosal invasion. PO could be considered a radical gastrectomy for T4a gastric cancer.

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Authors and Affiliations

  1. Department of Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, 25440, Korea

    Seong-A Jeong

  2. Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Korea

    Sehee Kim

  3. Department of Gastrointestinal Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea

    In-Seob Lee, Moon-Won Yoo & Beom Su Kim

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Dr. Seong-A Jeong, Sehee Kim, In-Seob Lee, Moon-Won Yoo, and Beom Su Kim have no conflicts of interest or financial ties to disclose.

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464_2023_10514_MOESM1_ESM.jpg

Supplementary file1 (JPG 67 KB) Kaplan–Meier survival curve of OS and RFS after TO depending on the surgical approach. (a) OS after PSM (five-year OS: Lap vs. Open, 49.2% vs. 51.2 ; p-value = 0.948); (b) RFS after PSM (five-year RFS: Lap vs. Open, 43.6% vs. 45.8; p-value = 0.959) OS, overall survival; RFS, recurrence-free survival; TO, total omentectomy; Lap, laparoscopy

Supplementary file2 (DOCX 20 KB)

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Jeong, SA., Kim, S., Lee, IS. et al. Does total omentectomy prevent peritoneal seeding for advanced gastric cancer with serosal invasion?. Surg Endosc 38, 97–104 (2024). https://doi.org/10.1007/s00464-023-10514-y

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