Is Omentectomy Mandatory in Patients With Epithelial Ovarian Cancer Having a Macroscopically Normal-Appearing Omentum?

INTRODUCTION: Although omentectomy is included as a typical staging surgical procedure for ovarian cancer, the routine performance of omentectomy for a normal-appearing omentum without suspected metastasis is questionable. Several studies have evaluated the effects of omentectomy on the outcomes in patients with cancer. However, the results are contradictory. OBJECTIVE: To determine the necessity of mandatory omentectomy during staging surgery in patients with epithelial ovarian cancer (EOC) with a normal-appearing omentum. METHODS: This study analyzed patients with EOC who underwent staging surgery at Korea University Anam Hospital between January 2010 and December 2023, excluding those with incomplete data and those lost to follow-up. The patients were categorized into the omentectomy and non-omentectomy groups. We compared the characteristics, disease-free survival (DFS), overall survival (OS), and recurrence risk factors, using statistical tests including the Student’s t-test, chi-square test, Fisher’s exact test, Kaplan–Meier analysis, and Cox regression, conducted with SPSS. RESULTS: Among 222 patients, 166 underwent omentectomy and 56 did not. The median follow-up period for all patients was 43 months, and no significant difference in DFS or OS was observed between the groups. Factors associated with increased EOC recurrence included advanced stages (stage III: adjusted hazard ratio (HR), 2.19; p=0.006 and stage IV: adjusted HR, 4.55; p<0.001), elevated cancer antigen (CA) 125 level (adjusted HR, 3.37; p<0.001), positive pelvic lymph nodes (adjusted HR, 2.34; p=0.001), more chemotherapy (adjusted HR, 1.05; p<0.001), and positive washing cytology (adjusted HR, 1.77; p=0.014) (Figure 1). CONCLUSIONS: Omentectomy status in patients with EOC with unsuspected omental metastasis was not associated with survival benefit, suggesting that omentectomy is not mandatory for a normal-appearing omentum and may be considered optional during staging surgery. To reduce the risk of recurrence, close monitoring is crucial for patients with advanced-stage EOC, elevated CA 125 level, positive pelvic lymph nodes, more chemotherapy, and positive washing cytology (Table 1).