胃癌行胃切除术加或不加网膜切除术：一项系统评价和荟萃分析。

Gastrectomy with or without omentectomy for gastric cancer: A systematic review and meta-analysis.

作者信息

Lin Ho-Wei, Loh El-Wui, Shen Shih-Chiang, Tam Ka-Wai

机构信息

School of Medicine, College of Medicine, Taipei Medical University, Taiwan. Electronic address: https://twitter.com/linhewei1.

Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taiwan; Center for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Cochrane Taiwan, Taipei Medical University, Taiwan.

出版信息

Surgery. 2022 May;171(5):1281-1289. doi: 10.1016/j.surg.2021.10.052. Epub 2021 Nov 29.

DOI:10.1016/j.surg.2021.10.052

PMID:34857385

Abstract

BACKGROUND

Omentectomy is conventionally performed in the procedure of gastrectomy for gastric cancer. However, the clinical value and importance of omentectomy remain unclear. This meta-analysis investigated the benefits and safety of gastrectomy with or without omentectomy for patients with gastric cancer.

METHODS

A literature search was conducted in PubMed, Embase, and the Cochrane Library for studies comparing complete omentectomy with omentum preservation or partial omentectomy. Primary outcomes were overall survival, relapse-free survival, and incidences of recurrence and complications, whereas secondary outcomes were the total length of operation and the amount of blood loss.

RESULTS

Nine studies involving 3,561 patients were included. Our meta-analysis revealed no significant differences between omentectomy and omentum preservation in terms of the 5-year overall survival (risk ratio [RR] = 0.95, 95% confidence interval [CI] = 0.89-1.01), 5-year relapse free survival (RR: 0.96, 95% CI: 0.89-1.03), incidence of recurrence in the peritoneum or other visceral organs (RR: 1.13, 95% CI: 0.80-1.60 and RR: 1.06, 95% CI: 0.78-1.45, respectively), and incidence of complications (RR: 1.15, 95% CI: 0.89-1.50). Moreover, omentum preservation significantly reduced the total length of operation (mean difference [MD] 25.70, 95% CI: 3.23-48.17) and the amount of blood loss (MD: 56.29, 95% CI: 14.02-98.56).

CONCLUSION

Omentectomy may not be necessary and can be omitted during gastrectomy for gastric cancer.

摘要

背景

在胃癌根治术中，传统上会进行网膜切除术。然而，网膜切除术的临床价值和重要性仍不明确。本荟萃分析探讨了胃癌患者行或不行网膜切除术的根治术的益处和安全性。

方法

在PubMed、Embase和Cochrane图书馆中进行文献检索，以查找比较完全网膜切除术与保留网膜或部分网膜切除术的研究。主要结局指标为总生存期、无复发生存期、复发和并发症发生率，次要结局指标为手术总时长和失血量。

结果

纳入了9项研究，共3561例患者。我们的荟萃分析显示，网膜切除术与保留网膜在5年总生存期（风险比[RR]=0.95，95%置信区间[CI]=0.89-1.01）、5年无复发生存期（RR：0.96，95%CI：0.89-1.03）、腹膜或其他内脏器官复发率（RR：分别为1.13，95%CI：0.80-1.60和RR：1.06，95%CI：0.78-1.45）以及并发症发生率（RR：1.15，95%CI：0.89-1.50）方面无显著差异。此外，保留网膜显著缩短了手术总时长（平均差[MD]25.70，95%CI：3.23-48.17）和减少了失血量（MD：56.29，95%CI：14.02-98.56）。