Abstract
ABSTRACTBackground: 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.
Highlights
The prognostic relevance of the multimodal treatment in gastric cancer (GC) has been well stablished[30]
It is believed that total omentectomy (TO) is essential to ensure the elimination of cancer cells during advanced GC surgery[11]
This study aimed to evaluate the incidence of metastatic lymph nodes (LN) in the greater omentum of patients who underwent radical gastrectomy for GC, as well as its risk factors and patients’ outcomes
Summary
The prognostic relevance of the multimodal treatment in gastric cancer (GC) has been well stablished[30]. It is believed that total omentectomy (TO) is essential to ensure the elimination of cancer cells during advanced GC surgery[11]. The greater omentum plays an important role in the peritoneal primary defense. Patients who undergo to TO are more vulnerable to peritoneal infections, which are often associated with worse clinical outcomes[4,26]. There is no consensus regarding the oncologic value of omentectomy in GC surgery between the European, American and Japanese guidelines. The European guideline provides no guidance on this subject[34], whereas the American guidelines recommend resection of the greater and lesser omentum[1]. The Japanese Gastric Cancer Association (JGCA) guidelines recommend the preservation of the omentum 3 cm distal to gastroepiploic vessels in patients with T1/T2 stage tumors and TO in T3/T4 tumors[19].
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