A comparison of total versus partial omentectomy for advanced gastric cancer in laparoscopic gastrectomy

Dong Jin Kim, Jun Hyun Lee, Wook Kim, Dong Jin Kim, Jun Hyun Lee, Wook Kim

Abstract

Background: Minimally invasive surgery has been slowly introduced into the field of advanced gastric cancer (AGC) surgery. However, the appropriate extent of omentectomy during laparoscopic gastrectomy for AGC is unknown.

Methods: From July 2004 to December 2011, 146 patients with serosa-negative advanced gastric cancer were divided into the total omentectomy group (TO group, n = 80) and the partial omentectomy group (PO group, n = 66). The clinicopathologic characteristics, surgical outcomes, recurrence pattern and survival were analyzed.

Results: There were no significant differences in the clinicopathologic features between the two groups, except for depth of invasion; more T3 (subserosal invasion) cases (65%) were included in total omentectomy group (P = 0.011). The mean time for PO was significantly shorter (35.1 ± 13.0 min) than TO (50.9 ± 15.3 min) (P %0.001), and there were two omentectomy-related complications in the TO group: spleen and mesocolon injuries. Recurrence occurred in 14 (17.5%) and 5 (7.6%) cases in the TO and PO group, respectively (P = 0.054). Disease-free survival (TO versus PO: 81.5% versus 89.3%, P = 0.420) and disease-specific survival (TO versus PO: 89% versus 94.7%) were not significantly different between the two groups. In the case-matched analysis using propensity score matching, there was no difference in disease-free survival (TO versus PO: 83.3% versus 90.5%, P = 0.442).

Conclusions: Partial omentectomy might be an oncologically safe procedure during laparoscopic gastrectomy for serosa-negative advanced gastric cancer, similar to early gastric cancer.

Figures

Figure 1
Figure 1
Survival analysis. (A) Disease-free survival did not differ between the total omentectomy (TO) and the partial omentectomy (PO) groups. (B) Disease-specific overall survival did not differ between the total omentectomy and the partial omentectomy groups. (C) Disease-free survival did not differ between the matched groups.

References

    1. Hamabe A, Omori T, Tanaka K, Nishida T. Comparison of long-term results between laparoscopy-assisted gastrectomy and open gastrectomy with D2 lymph node dissection for advanced gastric cancer. Surg Endosc. 2012;26:1702–1709. doi: 10.1007/s00464-011-2096-0.
    1. Lee J, Kim W. Long-term outcomes after laparoscopy-assisted gastrectomy for advanced gastric cancer: analysis of consecutive 106 experiences. J Surg Oncol. 2009;100:693–698. doi: 10.1002/jso.21400.
    1. Parkdo J, Han SU, Hyung WJ, Kim MC, Kim W, Ryu SY, Ryu SW, Song KY, Lee HJ, Cho GS, Kim HH. Long-term outcomes after laparoscopy-assisted gastrectomy for advanced gastric cancer: a large-scale multicenter retrospective study. Surg Endosc. 2012;26:1548–1553. doi: 10.1007/s00464-011-2065-7.
    1. Lee JS, Douglass HO Jr. D2 dissection for gastric cancer. Surg Oncol. 1997;6:215–225. doi: 10.1016/S0960-7404(98)00009-7.
    1. Oñate-Ocaña LF, Aiello-Crocifoglio V, Mondragón-Sánchez R, Ruiz-Molina JM. Survival benefit of D2 lympadenectomy in patients with gastric adenocarcinoma. Ann Surg Oncol. 2000;7:210–217. doi: 10.1007/BF02523656.
    1. Japanese Gastric Cancer A. Japanese gastric cancer treatment guidelines 2010 (ver. 3) Gastric Cancer. 2011;14:113–123.
    1. Hayashi H, Ochiai T, Shimada H, Gunji Y. Prospective randomized study of open versus laparoscopy-assisted distal gastrectomy with extraperigastric lymph node dissection for early gastric cancer. Surg Endosc. 2005;19:1172–1176. doi: 10.1007/s00464-004-8207-4.
    1. Kim YW, Baik YH, Yun YH, Nam BH, Kim DH, Choi IJ, Bae JM. Improved quality of life outcomes after laparoscopy-assisted distal gastrectomy for early gastric cancer: results of a prospective randomized clinical trial. Ann Surg. 2008;248:721–727. doi: 10.1097/SLA.0b013e318185e62e.
    1. Kitano S, Shiraishi N, Fujii K, Yasuda K, Inomata M, Adachi Y. A randomized controlled trial comparing open vs laparoscopy-assisted distal gastrectomy for the treatment of early gastric cancer: an interim report. Surgery. 2002;131:S306–311. doi: 10.1067/msy.2002.120115.
    1. Lee JH, Han HS. A prospective randomized study comparing open vs laparoscopy-assisted distal gastrectomy in early gastric cancer: early results. Surg Endosc. 2005;19:168–173. doi: 10.1007/s00464-004-8808-y.
    1. Ohtani H, Tamamori Y, Noguchi K, Azuma T, Fujimoto S, Oba H, Aoki T, Minami M, Hirakawa K. A meta-analysis of randomized controlled trials that compared laparoscopy-assisted and open distal gastrectomy for early gastric cancer. J Gastrointest Surg. 2010;14:958–964. doi: 10.1007/s11605-010-1195-x.
    1. Oosterling SJ, van der Bij GJ, Bögels M, van der Sijp JR, Beelen RH, Meijer S, van Egmond M. Insufficient ability of omental milky spots to prevent peritoneal tumor outgrowth supports omentectomy in minimal residual disease. Cancer Immunol Immunother. 2006;55:1043–1051. doi: 10.1007/s00262-005-0101-y.
    1. Lopes Cardozo AM, Gupta A, Koppe MJ, Meijer S, van Leeuwen PA, Beelen RJ, Bleichrodt RP. Metastatic pattern of CC531 colon carcinoma cells in the abdominal cavity: an experimental model of peritoneal carcinomatosis in rats. Eur J Surg Oncol. 2001;27:359–363. doi: 10.1053/ejso.2001.1117.
    1. Ha TK, An JY, Youn HG, Noh JH, Sohn TS, Kim S. Omentum-preserving gastrectomy for early gastric cancer. World J Surg. 2008;32:1703–1708. doi: 10.1007/s00268-008-9598-5.
    1. Kim MC, Kim KH, Jung GJ, Rattner DW. Comparative study of complete and partial omentectomy in radical subtotal gastrectomy for early gastric cancer. Yonsei Med J. 2011;52:961–966. doi: 10.3349/ymj.2011.52.6.961.
    1. Kim JH, Kang SH, Oh ST, Yook JH, Kim BS, Park KC. Following of the omentum preserving gastrectomy for advanced gastric cancer without serosa exposure. J Korean Surg Soc. 2009;76:154–158. doi: 10.4174/jkss.2009.76.3.154.
    1. Soga K, Ichikawa D, Yasukawa S, Kubota T, Kikuchi S, Fujiwara H, Okamoto K, Ochiai T, Sakakura C, Kokuba Y, Yanagisawa A, Otsuji E. Prognostic impact of the width of subserosal invasion in gastric cancer invading the subserosal layer. Surgery. 2010;147:197–203. doi: 10.1016/j.surg.2009.06.032.
    1. Moriguchi S, Maehara Y, Korenaga D, Sugimachi K, Nose Y. Risk factors which predict pattern of recurrence after curative surgery for patients with advanced gastric cancer. Surg Oncol. 1992;1:341–346. doi: 10.1016/0960-7404(92)90034-I.
    1. Fugita J, Tsukahara Y, Ikeda K, Akagi K, Kan K, Hata S. Evaluation of omentum preserving gastrectomy for advanced gastric cancer. Jpn J Gastroenterol Surg. 2003;36:1151–1158. doi: 10.5833/jjgs.36.1151.
    1. Oh JY, Cho JH, Kang MJ, Lee JH, Kwon HJ, Nam KJ, Kim MC, Choi H. Omental infarction caused by laparoscopy-assisted gastrectomy for gastric cancer: CT findings. Clin Radiol. 2011;66:966–973. doi: 10.1016/j.crad.2011.05.006.

Source: PubMed

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