Does total omentectomy increase survival in laparoscopic gastric cancer surgery? A retrospective study

In non-metastatic advanced gastric cancer, gastrectomy with D2 lymph node dissection is the main curative treatment. The clinical benefit of omentectomy in gastric cancer surgery is still controversial. We planned to investigate the effect of omentectomy in addition to curative laparoscopic surgery on patient survival in patients with gastric cancer in our clinic. We retrospectively reviewed the records of 265 patients who underwent laparoscopic gastrectomy for gastric adenocarcinoma between 2010 and 2023 in our clinic. The demographic and clinicopathologic data of the patients were obtained from the patient database. The patient population was divided into two different groups as partial and total omentectomy patients. Overall survival and disease free survival were performed by Kaplan-Meier analysis. P < 0.05 was considered statistically significant. Of the 265 patients whose data were obtained, 188 were included in the study. The median age of the patients was 64(53–71) and 122(35.1%) were male. In addition to gastrectomy and D2 dissection, 127(67.6%) patients underwent partial omentectomy and 61(32.4%) patients underwent total omentectomy. Complications requiring surgical procedure (Clavien Dindo 3a, 3b) developed in 44(23.4%) patients (Table 2). There was no statistical difference between the groups except for histologic aggressive type and complications requiring surgical procedure (p = 0.044, p = 0.004, respectively). There was no statistically significant difference between the groups according to the results of survey analysis and disease free survival. Our study demonstrated that partial omentectomy in laparoscopic curative gastric cancer surgery is similar to total omentectomy in patient survival, but the major complication rates after total omentectomy are higher. We have presented to the literature that partial omentectomy in laparoscopic gastric cancer surgery is sufficient in curative surgery except for aggressive tumor subtypes and does not have a negative result on patient survival. Randomized controlled and multicenter studies are needed to provide clearer messages.