The effect of omentum preservation in radical distal gastrectomy for gastric cancer: A retrospective comparison with complete omentum resection

To investigate the effect of omentum-preservation (OP) in radical distal gastrectomy for gastric cancer compared with complete omentum-resection (OR). We conducted a retrospective study involving 222 patients with gastric cancer who underwent radical distal gastrectomy at our center. According to the surgical approach, whether the greater omentum was completely resected, patients were assigned to the OP group (n = 114) and OR group (n = 108). We analyzed the baseline data, intraoperative data including operation time, as well as pathological characteristics. Additionally, we evaluated the 3-year disease-free survival(DFS) rate and overall survival (OS) rate. To reduce confounding factors, four variables were included in the propensity score-matching (PSM) analysis. No significant differences were found in baseline data or pathological characteristics between the two groups. However, the operation time (196.88 min vs 237.12 min, p < 0.001), intraoperative blood loss volume (50.70 ml vs 71.67 ml, p < 0.001), and postoperative hospital stay(9.04 days vs 10.44days, p = 0.021) were significantly lower in the OP group. In terms of the survival outcomes, there was no significant difference in 3-year DFS and OS between the two groups overall. However, in the subgroup analysis, for patients in pathological T3-4 stage with signet-ring cell carcinoma, the OR group showed better prognosis in both 3-year DFS and OS. Omentum-preservation in radical distal gastrectomy did not significantly affect the 3-year DFS and OS in patients with pathological T1-2 stage gastric cancer. However, for patients in pathological T3–4 stage, especially those with high malignant characteristics such as signet-ring cell carcinoma, complete omentum-resection is recommended.