Department of Surgery, Yokohama City University Medical Center, Urafune-cho 4-57, Minami-ku, Yokohama, 232-0024, Japan.
Gastric Cancer. 2013 Jul;16(3):383-8. doi: 10.1007/s10120-012-0198-6. Epub 2012 Sep 17.
We clarified the impact of omentectomy for advanced gastric cancer on patient survival from the surgical results of a high-volume center in Japan.
Patients who received curative gastrectomy were divided into two groups based on whether they underwent omentectomy. The propensity score-matching method was used to assemble a well-balanced cohort, and relapse-free survival and the pattern of recurrence were compared.
For this study, 330 patients who fulfilled the inclusion criteria participated and were divided into two groups: group R, patients who received omentectomy, and group P, patients who received omentum-preserving gastrectomy. After performing score-matching, 196 patients were selected. The 3- and 5-year relapse-free survival rates were 72.9% (95% confidence interval, 64.1-81.7) and 66.2% (56.6-75.8%) in group R, and 76.7% (67.9-81.2) and 67.3% (55.1-79.5) in group P, which were not significantly different (P = 0.750). Regarding sites of relapses, no differences were observed between the groups (P = 0.863).
In this series, omentum-preserving gastrectomy for advanced gastric cancer did not increase the peritoneal relapse rate or affect patient survival compared to conventional gastrectomy. The non-inferiority of the omission of omentectomy should be evaluated by a randomized controlled trial.
我们从日本一家大容量中心的手术结果中阐明了网膜切除术对晚期胃癌患者生存的影响。
根据是否进行网膜切除术，将接受根治性胃切除术的患者分为两组。采用倾向评分匹配法组建一个均衡的队列，并比较无复发生存率和复发模式。
本研究共纳入 330 例符合纳入标准的患者，并分为两组：R 组，行网膜切除术的患者；P 组，行保留网膜的胃切除术的患者。在进行评分匹配后，选择了 196 例患者。R 组的 3 年和 5 年无复发生存率分别为 72.9%（95%置信区间，64.1-81.7）和 66.2%（56.6-75.8%），P 组分别为 76.7%（67.9-81.2）和 67.3%（55.1-79.5），两组之间无显著差异（P=0.750）。关于复发部位，两组之间无差异（P=0.863）。
在本系列中，与常规胃切除术相比，晚期胃癌保留网膜的胃切除术并未增加腹膜复发率或影响患者生存。通过随机对照试验评估网膜切除术的省略是否具有非劣效性。
