Huang Biying, Kung Chih-Han, Tsekrekos Andrianos, Klevebro Fredrik, Mayerhofer Raphaela, Vossen Engblom Laura, Lindblad Mats, Hedberg Jakob, Szabo Eva, Edholm David, Smedh Ulrika, Johansson Jan, Rouvelas Ioannis, Nilsson Magnus
Division of Surgery and Oncology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, and Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden.
Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden.
BJS Open. 2025 Mar 4;9(2). doi: 10.1093/bjsopen/zraf012.
Omentectomy has traditionally been performed in gastric cancer surgery, but omental preservation has become increasingly common. It is unclear whether omentectomy leads to additional survival benefit compared with omental preservation. This nationwide population-based cohort study aimed to assess survival and surgical outcomes comparing omental preservation to omentectomy in curative-intent gastrectomy.
Patients were identified from the Swedish National Registry for Oesophageal and Gastric Cancer with inclusion between 2006 and 2022. The primary endpoint was overall survival assessed by a multivariable Cox proportional hazards model, adjusted for age, sex, American Society of Anesthesiologists physical status score, clinical T and N stage, type of gastrectomy, surgical approach, extent of lymphadenectomy, neoadjuvant chemotherapy, surgery year and regional cancer centre. Secondary endpoints were surgical outcomes including tumour-free resection margins, lymph node yield and postoperative complications.
A total of 1615 patients were included, 517 (32.0%) underwent gastrectomy with omental preservation, and 1098 (68.0%) underwent gastrectomy with omentectomy. Overall survival after omental preservation was similar compared with omentectomy in the multivariable Cox model (HR 1.00, 95% c.i. 0.83 to 1.20; P = 0.967). Omental preservation also had similar surgical outcomes including lymph node yield and postoperative morbidity rate, compared with omentectomy.
Omental preservation was similar to omentectomy in terms of overall survival and surgical outcomes. The results suggest that omentectomy can safely be omitted in curative-intent gastrectomy for gastric cancer.
在胃癌手术中，传统上会进行网膜切除术，但保留网膜的情况越来越普遍。与保留网膜相比，网膜切除术是否能带来额外的生存获益尚不清楚。这项基于全国人群的队列研究旨在评估在根治性意图胃切除术中，保留网膜与网膜切除术相比的生存情况和手术结果。
从瑞典国家食管癌和胃癌登记处确定2006年至2022年间纳入的患者。主要终点是通过多变量Cox比例风险模型评估的总生存期，该模型根据年龄、性别、美国麻醉医师协会身体状况评分、临床T和N分期、胃切除术类型、手术入路、淋巴结清扫范围、新辅助化疗、手术年份和区域癌症中心进行了调整。次要终点是手术结果，包括无肿瘤切缘、淋巴结收获量和术后并发症。
共纳入1615例患者，517例（32.0%）接受了保留网膜的胃切除术，1098例（68.0%）接受了网膜切除术。在多变量Cox模型中，保留网膜后的总生存期与网膜切除术相似（风险比1.00，95%置信区间0.83至1.20；P = 0.967）。与网膜切除术相比，保留网膜在包括淋巴结收获量和术后发病率在内的手术结果方面也相似。
在总生存期和手术结果方面，保留网膜与网膜切除术相似。结果表明，在胃癌根治性意图胃切除术中可以安全地省略网膜切除术。
Zotero 插件
