Department of Evidence-Based Medicine, Faculdade de Ciências Médicas de Santos - UNILUS, Santos, SP, Brazil.
Department of Surgery, Faculdade de Ciências Médicas de Santos - UNILUS, Santos, SP, Brazil.
Surg Oncol. 2023 Aug;49:101963. doi: 10.1016/j.suronc.2023.101963. Epub 2023 Jun 10.
Currently, gastric cancer is the sixth most prevalent cancer in the world. The recommended treatment for advanced disease is gastrectomy with D2 lymphadenectomy. However, there is no consensus regarding the performance of an omentectomy as part of the treatment. The procedure is considered by some authors to be essential for the elimination of a micrometastasis since cells in the peritoneum prefer growing in milky spots in the omentum. On the other hand, retrospective studies demonstrated that there is the possibility that omentum preservation may not impact patients' overall survival. Therefore, the objective of this review was to quantify the effect of performing an omentectomy to determine whether it is necessary. Medline (PubMed), Embase, Cochrane, ClinicalTrials.gov and LILACS were searched up to September 2022. Selection was restricted to comparative studies in patients with advanced GC (≥T2). The certainty of evidence was assessed with GRADEPro and the risk of bias with ROBINS-I and RoB 2.0. Five cohort studies, and one randomized controlled trial (RCT) were included. The meta-analysis found that there were no significant differences between the procedures for overall survival, relapse-free survival, and peritoneal recurrence. Furthermore, in perioperative outcomes, a significant difference was only found in intraoperative bleeding, which was lower in patients who had their omentum preserved. Therefore, omentum preservation in patients with advanced gastric cancer has been shown to have no inferior results than resection in long-term outcomes.
目前，胃癌是全球第六大常见癌症。对于晚期疾病，推荐的治疗方法是胃切除术和 D2 淋巴结清扫术。然而，对于是否进行网膜切除术作为治疗的一部分，尚未达成共识。一些作者认为，该手术对于消除微转移是必要的，因为腹膜中的细胞更喜欢在大网膜的乳斑中生长。另一方面，回顾性研究表明，保留网膜可能不会影响患者的总生存。因此，本综述的目的是量化进行网膜切除术的效果，以确定其是否必要。截至 2022 年 9 月，检索了 Medline（PubMed）、Embase、Cochrane、ClinicalTrials.gov 和 LILACS。选择仅限于患有晚期 GC（≥T2）的患者的比较研究。使用 GRADEPro 评估证据确定性，并使用 ROBINS-I 和 RoB 2.0 评估偏倚风险。共纳入了五项队列研究和一项随机对照试验（RCT）。荟萃分析发现，总体生存、无复发生存和腹膜复发方面，两种手术方式无显著差异。此外，在围手术期结果中，仅术中出血存在显著差异，保留网膜的患者术中出血较少。因此，在长期结果方面，与切除相比，保留晚期胃癌患者的网膜并未显示出较差的结果。
