Role of omentectomy as part of radical surgery for gastric cancer.

Autor: Jongerius EJ; Departments of Surgery, Academic Medical Centre, Amsterdam, The Netherlands., Boerma D; Departments of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands., Seldenrijk KA; Departments of Pathology, St Antonius Hospital, Nieuwegein, The Netherlands., Meijer SL; Departments of Pathology, Academic Medical Centre, Amsterdam, The Netherlands., Scheepers JJ; Departments of Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands., Smedts F; Departments of Pathology, Reinier de Graaf Gasthuis, Delft, The Netherlands., Lagarde SM; Departments of Surgery, Academic Medical Centre, Amsterdam, The Netherlands., Balague Ponz O; Departments of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands., van Berge Henegouwen MI; Departments of Surgery, Academic Medical Centre, Amsterdam, The Netherlands., van Sandick JW; Departments of Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands., Gisbertz SS; Departments of Surgery, Academic Medical Centre, Amsterdam, The Netherlands. s.s.gisbertz@amc.nl.
Jazyk: angličtina
Zdroj: The British journal of surgery [Br J Surg] 2016 Oct; Vol. 103 (11), pp. 1497-503. Date of Electronic Publication: 2016 Aug 23.
DOI: 10.1002/bjs.10149
Abstrakt: Background: A complete omentectomy is recommended as part of radical (sub)total gastrectomy for gastric cancer, but there is little evidence to suggest any survival benefit. The aim of this study was to evaluate the incidence of, and risk factors for, metastases in the greater omentum in patients undergoing gastrectomy for gastric cancer.
Methods: This was a multicentre prospective cohort study (OMEGA trial) of consecutive patients with gastric cancer undergoing (sub)total gastrectomy with complete en bloc omentectomy and modified D2 lymphadenectomy. After resection, the omentum was separated from the gastrectomy specimen distal to the gastroepiploic vessels and sent separately for pathological examination. The primary endpoint was the presence of metastases in the greater omentum.
Results: Of 100 included patients, five (5·0 per cent) had metastases in the greater omentum. Pathology results showed advanced tumours in all five (pT4b N1 M1, pT4b N2 M1, ypT4a N1 M1, ypT3 N2 M0, ypT3 N3 M0). The resection was microscopically non-radical at the proximal (3) or distal (2) resection margin in all of these patients. Metastases in the greater omentum correlated significantly with a microscopically non-radical resection, tumour expansion in the oesophagus or duodenum, linitis plastica or a proximal gastric tumour with diameter of at least 5 cm, stage III-IV disease and (y)pM1 category.
Conclusion: In resectable gastric cancer, the incidence of metastases in the greater omentum is low, and when present associated with advanced disease and non-radical features. Thus, omentectomy as part of a radical gastrectomy may be omitted.
Registration Number: NCT02050659 ( http://www.clinicaltrials.gov).
(© 2016 BJS Society Ltd Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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