Department of Gastric Surgery, Shanghai Cancer Center, Fudan University, Shanghai, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
Cancer Med. 2023 Jan;12(2):1204-1216. doi: 10.1002/cam4.4980. Epub 2022 Jul 20.
Total omentectomy is often performed with gastrectomy as radical surgery for gastric cancer (GC) patients. However, it remains controversial whether GC patients can benefit from omentectomy. The aim of this study was to analyze the incidence and clinical significance of tumor deposits (TDs) in different anatomical subregions of perigastric omentum in GC patients undergoing gastrectomy with total omentectomy.
From October 2011 to December 2013, 1253 patients who underwent gastrectomy with total omentectomy for GC were retrospective reviewed. The TDs in different anatomical subregions of perigastric omentum were examined.
Of 1253 patients, TDs positivity was 11.2%. Tumor deposits in the omentum of greater curvature and in the omentum of lesser curvature were associated with lymphovascular invasion, perineural invasion, advanced tumor node metastasis stages, and unfavorable survival. Besides, TDs in the proximal omentum of greater curvature and in the omentum of lesser curvature correlated with older patients and larger tumors. Kaplan-Meier curves showed that patients with TDs had worser overall survival (OS) than those without, regardless of TD positions. Patients with TDs in the omentum of greater curvature had the worst prognosis, followed by patients with TDs in the omentum of lesser curvature and patients with no TDs. Tumor deposits in the proximal omentum of greater curvature was an independent prognostic factor for OS. Moreover, only patients classified as pT4 had TDs in the distal omentum of greater curvature.
Patients with TDs in the omentum of greater curvature had the worst prognosis, followed by patients with TDs in the omentum of lesser curvature and patients with no TDs. In addition, partial omentectomy might be practicable for gastric cancer patients classified as T3 or shallower tumors.
全网膜切除术常与胃癌（GC）根治性胃切除术一并施行。然而，GC 患者是否能从网膜切除术中获益仍存在争议。本研究旨在分析行全网膜切除术的 GC 患者胃周网膜不同解剖分区肿瘤沉积物（TDs）的发生率及其临床意义。
回顾性分析 2011 年 10 月至 2013 年 12 月 1253 例行全网膜切除术的 GC 患者的临床资料，检查胃周网膜不同解剖分区 TDs 的情况。
1253 例患者中，TDs 阳性率为 11.2%。大网膜和小网膜 TDs 与淋巴血管侵犯、神经周围侵犯、肿瘤淋巴结转移分期较晚及预后不良相关。此外，大网膜近段和小网膜 TDs 与患者年龄较大、肿瘤较大有关。Kaplan-Meier 曲线显示，无论 TD 位置如何，有 TDs 的患者总生存（OS）均较无 TDs 的患者差。大网膜 TDs 患者的预后最差，其次是小网膜 TDs 患者，无 TDs 患者的预后最好。大网膜近段 TDs 是 OS 的独立预后因素。此外，仅 pT4 患者的大网膜远段才有 TDs。
大网膜 TDs 患者的预后最差，其次是小网膜 TDs 患者，无 TDs 患者的预后最好。此外，对于 T3 或较浅肿瘤的胃癌患者，可行部分网膜切除术。
