Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research.
Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan.
Br J Surg. 2020 Nov;107(12):1640-1647. doi: 10.1002/bjs.11702. Epub 2020 May 20.
Omentectomy is performed widely for locally advanced gastric cancer to prevent disease recurrence. However, its clinical benefit is unknown.
This retrospective cohort study compared the outcome of gastrectomy with preservation of the omentum (GPO) and gastrectomy with resection of the omentum (GRO) among patients with cT3-T4 gastric cancer who underwent gastrectomy between 2006 and 2012 in one of five participating institutions. A consensus conference identified 28 variables potentially associated with outcome after gastrectomy for the estimation of propensity scores, and propensity score matching (PSM) was undertaken to control for possible confounders. Postoperative surgical outcomes, overall survival and disease recurrence were compared between GPO and GRO.
A total of 1758 patients were identified, of whom 526 remained after PSM, 263 in each group. Median follow-up was 4·9 (i.q.r. 3·1-5·9) years in the GRO group and 5·0 (2·5-6·8) years in the GPO group. The incidence of postoperative complications of Clavien-Dindo grade III or more was significantly higher in the GRO group (17·5 versus 10·3 per cent; P = 0·016). Five-year overall survival rates were 77·1 per cent in the GRO group and 79·4 per cent in the GPO group (P = 0·749). There were no significant differences in recurrence rate or pattern of recurrence between the groups.
Overall survival and disease recurrence were comparable in patients with cT3-4 gastric cancer who underwent GPO or GRO.
广泛施行网膜切除术以预防局部晚期胃癌的疾病复发。然而，其临床获益尚不清楚。
本回顾性队列研究比较了 2006 年至 2012 年期间在五家参与机构之一接受胃切除术的 cT3-T4 胃癌患者中保留网膜的胃切除术（GPO）和切除网膜的胃切除术（GRO）的治疗结果。通过共识会议确定了 28 个潜在与胃切除术后结果相关的变量，以估计倾向评分，并进行倾向评分匹配（PSM）以控制可能的混杂因素。比较 GPO 和 GRO 两组之间的术后手术结局、总生存和疾病复发情况。
共纳入 1758 例患者，其中 526 例患者在 PSM 后仍保留，每组 263 例。GRO 组的中位随访时间为 4.9（IQR 3.1-5.9）年，GPO 组为 5.0（2.5-6.8）年。GRO 组术后并发症 Clavien-Dindo 分级 III 级或更高级别的发生率明显更高（17.5%比 10.3%；P=0.016）。GRO 组和 GPO 组的 5 年总生存率分别为 77.1%和 79.4%（P=0.749）。两组之间的复发率或复发模式无显著差异。
在接受 GPO 或 GRO 的 cT3-4 胃癌患者中，总生存和疾病复发情况相当。
