Ilhan Enver, Yildirim Mehmet
Department of General Surgery, University of Health Sciences Turkey, Izmir Faculty of Medicine, Izmir City Hospital, İzmir 35530, Türkiye.
World J Gastrointest Surg. 2025 Aug 27;17(8):108110. doi: 10.4240/wjgs.v17.i8.108110.
Despite the advancement of technology and neoadjuvant/adjuvant chemotherapy, molecular targeted agents, gastrectomy, and D2 lymph node dissection are the only curative treatment option for advanced gastric cancer (GC). The most common sites of recurrence in patients with GC are the peritoneum and omentum. The omentum contains areas rich in lymphatic tissue (the milky area) that form the connection between the peritoneum and the lymphatic system. Tumor cells are often found in these areas. Therefore, omentectomy is added to radical gastric resection and modified D2 lymph node dissection in the treatment of GC. Total omentectomy is recommended by Western countries for GC diagnosed at T3-4 stage, while Japanese research suggests partial omentectomy at T1-2 stage and total omentectomy at T3-4 stage due to early diagnosis of GC. In addition to the differences in tumor biology, the fact that patients in Western countries are more likely to receive perioperative chemotherapy and the 5% incidence of omental metastasis in advanced disease has led to the belief that partial omentectomy is an adequate surgical procedure compared with total omentectomy. There are studies recommending total omentectomy for the removal of possible tumor foci, and there are some studies reporting that partial omentectomy is sufficient even in advanced GC. The aim of this review was to investigate whether total or partial omentectomy should be performed in patients with GC.
尽管技术不断进步以及新辅助/辅助化疗、分子靶向药物、胃切除术和D2淋巴结清扫术取得了进展，但对于晚期胃癌（GC）而言，这些仍是仅有的根治性治疗选择。GC患者最常见的复发部位是腹膜和大网膜。大网膜含有富含淋巴组织的区域（乳糜区），这些区域构成了腹膜与淋巴系统之间的连接。肿瘤细胞常出现在这些区域。因此，在GC治疗中，网膜切除术被添加到根治性胃切除术和改良D2淋巴结清扫术中。西方国家对于T3 - 4期诊断的GC推荐行全网膜切除术，而日本的研究表明，由于GC的早期诊断，T1 - 2期行部分网膜切除术，T3 - 4期行全网膜切除术。除了肿瘤生物学差异外，西方国家患者更倾向于接受围手术期化疗以及晚期疾病中大网膜转移发生率为5%，这使得人们认为与全网膜切除术相比，部分网膜切除术是一种足够的手术方式。有研究推荐行全网膜切除术以清除可能的肿瘤病灶，也有一些研究报告称即使在晚期GC中，部分网膜切除术也足够了。本综述的目的是研究GC患者应行全网膜切除术还是部分网膜切除术。
