Abstract
The generally accepted standard surgery for advanced gastric cancer in Japan is gastrectomy with D2 lymph node dissection accompanied by omentobursectomy, but the significance of prophylactic omentobursectomy in survival after gastrectomy remains unproved. Since 1996, we have used gastrectomy preserving the omental bursa for both early and some advanced gastric cancers under a restricted criterion. We retrospectively studied whether surgical removal of the omental bursa improved survival from gastric cancer, and evaluated adverse complications caused by omentobursectomy. Methods: Subjects were 188 T2 or T3 gastric cancer patients undergoing curative gastrectomy-97 involving omental bursa preserving gastrectomy (OPG) and 91 gastrectomy with resection of omental bursa (OB). We compared surgical stress, postoperative complications, the incidence of surgically induced mechanical ileus, the incidence and pattern of cancer recurrence, and survival between OPG and OB. Results: Operation time, blood loss, and serum amylase on postoperative day (POD) 1 were significantly greater in OB than OPG. The incidence of early postoperative complications was 13.4% in OPG and 20.9% in OB. Among subjects, 11 (12.1%) suffered mechanical ileus in BG, compared to 3 (3.1%) in OPG. No significant difference was seen in the incidence of peritoneal recurrence between groups. Five-year survival in OPG vs OB was 81.3% vs 75.9% in stage IB, 77.8% vs 66.7% in stage II, and 40.0% vs 43.8% in stage IIIA, showing no significant difference between groups. Conclusion: OPG resulted in less surgical stress and fewer postoperative complications with survival similar to OB. These results suggest that omental bursa preserving gastrectomy may be applicable to T2 or T3 advanced gastric cancer patients. A prospective randomized controlled trial comparing these 2 procedures is recommended to clarify the clinical contribution of omentobursectomy.
