Department of Surgery, Korea University College of Medicine, Seoul, Korea.
Department of Surgery, Yonsei University College of Medicine, Seoul, Korea; Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea.
Surgery. 2021 Aug;170(2):610-616. doi: 10.1016/j.surg.2021.02.008. Epub 2021 Mar 11.
Total omentectomy has conventionally been performed and has been regarded as standard procedure in radical gastrectomy for cancer. However, omentum preservation is the preferred procedure during minimally invasive surgery, without sufficient evidence of oncological safety, especially for T3-T4 gastric cancer.
A total of 3,510 patients who underwent radical gastrectomy for T3-T4 gastric cancer between January 2003 and December 2015 were reviewed, retrospectively. After propensity score matching, 225 patients in the omentum preservation group were compared with 225 patients in the total omentectomy group. The primary outcome was 5-year overall survival.
The omentum preservation group showed significantly shorter operation time (P = .001) and less blood loss (P = .004) than the total omentectomy group. Shorter operation time was also observed with both open and minimally invasive approaches (P < .001 and P = .007, respectively). The 5-year overall survival rates were 75.4% for the omentum preservation group and 72.6% for the total omentectomy group (log-rank P = .06; hazard ratio 0.7 [95% confidence interval, 0.48-1.01]). The 5-year relapse-free survival was higher in the omentum preservation group (73.8%) than in the total omentectomy group (66.1%), without statistical significance (log-rank P = .09; hazard ratio 0.74 [95% confidence interval, 0.52-1.06]).
Regardless of the surgical approach, omentum preservation provided comparable oncologic outcomes with better surgical outcomes, suggesting that this could be an acceptable alternative to total omentectomy for T3-T4 gastric cancer. These findings warrant further investigation in randomized clinical trials.
全网膜切除术在根治性胃癌手术中一直被视为标准手术，但在微创手术中更倾向于保留网膜，虽然这一术式在肿瘤安全性方面没有足够的证据，特别是对于 T3-T4 期胃癌。
回顾性分析了 2003 年 1 月至 2015 年 12 月期间接受 T3-T4 期胃癌根治性手术的 3510 例患者的资料。经过倾向评分匹配后，将 225 例保留网膜组与 225 例全网膜切除术组进行比较。主要观察指标为 5 年总生存率。
保留网膜组的手术时间明显短于全网膜切除术组（P =.001），术中出血量也明显少于全网膜切除术组（P =.004）。开放性和微创手术的手术时间也更短（P <.001 和 P =.007）。保留网膜组的 5 年总生存率为 75.4%，全网膜切除术组为 72.6%（对数秩检验 P =.06；风险比 0.7 [95%置信区间，0.48-1.01]）。保留网膜组的 5 年无复发生存率（73.8%）高于全网膜切除术组（66.1%），但差异无统计学意义（对数秩检验 P =.09；风险比 0.74 [95%置信区间，0.52-1.06]）。
无论手术方式如何，保留网膜均可获得与全网膜切除术相当的肿瘤学结果，并具有更好的手术结果，提示对于 T3-T4 期胃癌，保留网膜术可能是全网膜切除术的一种可接受的替代方法。这些发现需要进一步的随机临床试验来验证。
