Comparative Study of Complete and Partial Omentectomy in Radical Subtotal Gastrectomy for Early Gastric Cancer

Purpose Curative surgery for patients with advanced or even early gastric cancer can be defined as resection of the stomach and dissection of the first and second level lymph nodes, including the greater omentum. The aim of this study was to evaluate the short- and long- term outcomes of partial omentectomy (PO) as compared with complete omentectomy (CO). Materials and Methods Seventeen consecutive open distal gastrectomies with POs were initially performed between February and July in 2006. The patients' clinicopathologic data and post-operative outcomes were retrospectively compared with 20 patients who underwent open distal gastrectomies with COs for early gastric cancer in 2005. Results The operation time in PO group was significantly shorter than that in CO group (142.4 minutes vs. 165.0 minutes, p=0.018). The serum albumin concentration on the first post-operative day in PO group was significantly higher than CO group (3.8 g/dL vs. 3.5 g/dL, p=0.018). Three postoperative minor complications were successfully managed with conservative treatment. Median follow-up period between PO and CO was 38.1 and 37.7 months. All patients were alive without recurrence until December 30, 2009. Conclusion PO during open radical distal gastrectomy can be considered a more useful procedure than CO for treating early gastric cancer. To document the long-term technical and oncologic safety of this procedure, a large-scale prospective randomized trial will be needed.

[1]  J. Sammon,et al.  Robot‐assisted radical prostatectomy: learning rate analysis as an objective measure of the acquisition of surgical skill , 2010, BJU international.

[2]  Sang-Uk Han,et al.  Morbidity and Mortality of Laparoscopic Gastrectomy Versus Open Gastrectomy for Gastric Cancer: An Interim Report—A Phase III Multicenter, Prospective, Randomized Trial (KLASS Trial) , 2010, Annals of surgery.

[3]  K. Yanaga,et al.  Laparoscopic total gastrectomy with D2 lymph node dissection for gastric cancer. , 2009, Archives of surgery.

[4]  K. Davis,et al.  Factors predicting morbidity and mortality in emergency colorectal procedures in elderly patients. , 2009, Archives of surgery.

[5]  Wook Kim,et al.  Long‐term outcomes after laparoscopy‐assisted gastrectomy for advanced gastric cancer: Analysis of consecutive 106 experiences , 2009, Journal of surgical oncology.

[6]  S. Ryu,et al.  Multicentre study of the safety of laparoscopic subtotal gastrectomy for gastric cancer in the elderly , 2009, The British journal of surgery.

[7]  Woong Youn Chung,et al.  Robotic thyroid surgery using a gasless, transaxillary approach and the da Vinci S system: the operative outcomes of 338 consecutive patients. , 2009, Surgery.

[8]  M. Karpeh,et al.  The role of laparoscopy for gastric surgery in the West , 2009, Gastric Cancer.

[9]  Ali Uzunkoy,et al.  Omentektominin bakteriyel çoğalma üzerine etkisi: Deneysel çalışma , 2009 .

[10]  L. El-Kadre,et al.  Laparoscopic Gastrectomy for Gastric Cancer , 2009, Surgical laparoscopy, endoscopy & percutaneous techniques.

[11]  Sun-Hwi Hwang,et al.  Safety of extended endoscopic mucosal resection and endoscopic submucosal dissection following the Japanese Gastric Cancer Association treatment guidelines , 2009, The British journal of surgery.

[12]  Sam S. Yoon,et al.  Lymphadenectomy for gastric adenocarcinoma: should west meet east? , 2009, The oncologist.

[13]  D. Park,et al.  Actual 3-year survival after laparoscopy-assisted gastrectomy for gastric cancer. , 2009, Archives of surgery.

[14]  M. Gonen,et al.  Laparoscopic Versus Open Subtotal Gastrectomy for Adenocarcinoma: A Case–Control Study , 2009, Annals of Surgical Oncology.

[15]  K. Song,et al.  The Impact of Comorbidity on Surgical Outcomes in Laparoscopy-Assisted Distal Gastrectomy: A Retrospective Analysis of Multicenter Results , 2008, Annals of surgery.

[16]  K. Song,et al.  Risk Factors Associated with Complication Following Laparoscopy-Assisted Gastrectomy for Gastric Cancer: A Large-Scale Korean Multicenter Study , 2008, Annals of Surgical Oncology.

[17]  J. Reynolds,et al.  Association of Hypoalbuminemia on the First Postoperative Day and Complications Following Esophagectomy , 2007, Journal of Gastrointestinal Surgery.

[18]  G. Jung,et al.  Techniques and complications of laparoscopy-assisted distal gastrectomy (LADG) for gastric cancer. , 2007, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[19]  Norio Shiraishi,et al.  A Multicenter Study on Oncologic Outcome of Laparoscopic Gastrectomy for Early Cancer in Japan , 2007, Annals of surgery.

[20]  S. Meijer,et al.  Insufficient ability of omental milky spots to prevent peritoneal tumor outgrowth supports omentectomy in minimal residual disease , 2006, Cancer Immunology, Immunotherapy.

[21]  Kazuhiro Yasuda,et al.  Laparoscopic gastrectomy with lymph node dissection for gastric cancer , 2006, Gastric Cancer.

[22]  J. Cheong,et al.  Minimally invasive treatment for gastric cancer: Approaches and selection process , 2005, Journal of surgical oncology.

[23]  Cristiano G S Huscher,et al.  Laparoscopic Versus Open Subtotal Gastrectomy for Distal Gastric Cancer: Five-Year Results of a Randomized Prospective Trial , 2005, Annals of surgery.

[24]  Toshihiro Saito,et al.  Treatment strategy of limited surgery in the treatment guidelines for gastric cancer in Japan. , 2003, The Lancet. Oncology.

[25]  U. Metzger,et al.  Perioperative detection of disseminated tumour cells is an independent prognostic factor in patients with colorectal cancer , 2003, The British journal of surgery.

[26]  S. Kitano,et al.  Indications for pylorus-preserving gastrectomy for gastric cancer based on lymph node metastasis. , 2002, Hepato-gastroenterology.

[27]  Y. Kodera,et al.  Quantitative detection of disseminated cancer cells in the greater omentum of gastric carcinoma patients with real-time RT-PCR: a comparison with peritoneal lavage cytology , 2002, Gastric Cancer.

[28]  T. Nakajima.  Gastric cancer treatment guidelines in Japan , 2002, Gastric Cancer.

[29]  M. Kaminishi,et al.  Wider indications for the local resection of gastric cancer by adjacent lymphadenectomy , 2000, Journal of surgical oncology.

[30]  H. Ngan,et al.  FIGO staging classifications and clinical practice guidelines in the management of gynecologic cancers. FIGO Committee on Gynecologic Oncology. , 2000, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[31]  C. Sakakura,et al.  Complete omentectomy and extensive lymphadenectomy with gastrectomy improves the survival of gastric cancer patients with metastases in the adjacent peritoneum. , 1998, Hepato-gastroenterology.

[32]  H. Katai,et al.  Surgical treatment for gastric cancer: the Japanese approach. , 1996, Seminars in oncology.

[33]  M. Horoz,et al.  The influence of omentectomy on bacterial clearance: an experimental study. , 2009, Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES.

[34]  S. N. Kim,et al.  Treatment results for gastric cancer surgery: 12 years' experience at a single institute in Korea. , 2008, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[35]  M. Kitajima,et al.  Sentinel node for gastrointestinal malignancies. , 2007, Surgical oncology clinics of North America.

[36]  Ph.D. Ulf H. Haglund M.D.,et al.  Current management of gastric cancer , 2007, Journal of Gastrointestinal Surgery.