Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Feb 7;32(1):e1425.
doi: 10.1590/0102-672020180001e1425.

TOTAL OMENTECTOMY IN GASTRIC CANCER SURGERY: IS IT ALWAYS NECESSARY?

[Article in English, Portuguese]
Leandro Cardoso Barchi  1 , Marcus Fernando Kodama Pertille Ramos  1 , André Roncon Dias  1 , Osmar Kenji Yagi  1 , Ulysses Ribeiro-Júnior  1 , Bruno Zilberstein  1 , Ivan Cecconello  1
Affiliations

TOTAL OMENTECTOMY IN GASTRIC CANCER SURGERY: IS IT ALWAYS NECESSARY?

[Article in English, Portuguese]
Leandro Cardoso Barchi et al. Arq Bras Cir Dig. .

Abstract
in English, Portuguese

Background: Traditionally, total omentectomy is performed along with gastric resection and extended lymphadenectomy in gastric cancer (GC) surgery. However, solid evidences regarding its oncologic benefit is still scarce.

Aim: To evaluate the incidence of metastatic omental lymph nodes (LN) in patients undergoing curative gastrectomy for GC, as well as its risk factors and patients' outcomes.

Methods: All consecutive patients submitted to D2/modified D2 gastrectomy due to gastric adenocarcinoma from March 2009 to April 2016 were retrospectively reviewed from a prospective collected database.

Results: Of 284 patients included, five (1.8%) patients had metastatic omental LN (one: pT3N3bM0; two: pT4aN3bM0; one: pT4aN2M0 and one pT4bN3bM0). Four of them deceased and one was under palliative chemotherapy due relapse. LN metastases in the greater omentum significantly correlated with tumor's size (p=0.018), N stage (p<0.001), clinical stage (p=0.022), venous invasion growth (p=0.003), recurrence (p=0.006), site of recurrence (peritoneum: p=0.008; liver: p=0.023; ovary: p=0.035) and death (p=0.008).

Conclusion: The incidence of metastatic omental LN of patients undergoing radical gastrectomy due to GC is extremely low. Total omentectomy may be avoided in tumors smaller than 5.25 cm and T1/T2 tumors. However, the presence of lymph node metastases in the greater omentum is associated with recurrence in the peritoneum, liver, ovary and death.

Racional:: Tradicionalmente a omentectomia total é realizada juntamente com a ressecção gástrica associada à linfadenectomia na cirurgia do câncer gástrico. No entanto, evidências sólidas em relação ao seu benefício oncológico são escassas .

Objetivo: Avaliar a incidência de metástases em linfonodos do omento maior em pacientes submetidos à gastrectomia potencialmente curativa por câncer gástrico, assim como, avaliar os fatores de risco para a ocorrência e a evolução dos pacientes.

Métodos:: Pacientes consecutivos submetidos à gastrectomia D2/D2 modificada devido ao adenocarcinoma gástrico foram analisados retrospectivamente a partir de um banco de dados.

Resultados:: Dos 284 pacientes, cinco (1,8%) tinham linfonodos metastáticos no omento maior (um pT3N3bM0; dois pT4aN3bM0; um pT4aN2M0 e um pT4bN3bM0). Quatro faleceram e um estava em tratamento paliativo com quimioterapia devido à recidiva da doença. Os linfonodos metastáticos no omento maior tiveram correlação significativa com o tamanho do tumor (p=0,018), estádio N (p<0,001), estádio clínico (p=0,022), invasão venosa (p=0,003), recorrência (p=0,006), local de recorrência (peritônio p=0,008; fígado p=0,023; ovário p=0,035) e óbito (p=0,008).

Conclusão:: A incidência de linfonodos metastático no omento maior de pacientes submetidos à gastrectomia radical por câncer gástrico é baixa. A omentectomia total pode ser evitada em tumores menores que 5,25 cm e estádios T1/T2. Entretanto, a presença de metástases linfonodais no omento maior está associada à recidiva no peritônio, fígado, ovário e óbito.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: none

Figures

FIGURE 1
FIGURE 1. Surgical specimen of subtotal gastrectomy with the greater omentum and lymph node chains dissected and sent in separate for histopathological analysis
FIGURE 2
FIGURE 2. The area under the ROC curve (0.8072 - (IC95%:0.6645 - 0.9498) shows that patients with metastatic LN in the omentum have larger tumors
FIGURE 3
FIGURE 3. Kaplan-Meier curve of survival: each line represents the OS of patients within a single clinical stage (TNM 7th edition). The arrow indicates patients with omental metastatic LN
See this image and copyright information in PMC

References

    1. Ajani JA, Barthel JS, Bekaii-Saab T, Bentrem DJ, D’Amico TA, Das P, et al. Gastric cancer. J Natl Compr Canc Netw. 2010;8(4):378–409. http://www.ncbi.nlm.nih.gov/pubmed/20410333 - PubMed
    1. Badgwell B, Blum M, Das P, Estrella J, Wang X, Ho L, et al. Phase II Trial of Laparoscopic Hyperthermic Intraperitoneal Chemoperfusion for Peritoneal Carcinomatosis or Positive Peritoneal Cytology in Patients with Gastric Adenocarcinoma. Ann Surg Oncol. 2017;24(11):3338–3344. http://www.ncbi.nlm.nih.gov/pubmed/28799004 - PubMed
    1. Barchi LC, Yagi OK, Jacob CE, Mucerino DR, Ribeiro U, Marrelli D, et al. Predicting recurrence after curative resection for gastric cancer. Eur J Surg Oncol. 2016;42(1):123–131. http://www.ncbi.nlm.nih.gov/pubmed/26365755 - PubMed
    1. Beelen RH. Role of omental milky spots in the local immune response. Lancet (London, England) 1992;339(8794):689–689. http://www.ncbi.nlm.nih.gov/pubmed/1347391 - PubMed
    1. Cerci C, Eroglu E, Sutcu R, Celikbas B, Kilbas A. Effects of omentectomy on the peritoneal fibrinolytic system. Surg Today. 2008;38(8):711–715. http://www.ncbi.nlm.nih.gov/pubmed/18668314 - PubMed