Background

Since 1910, omentectomy has been an essential component of radical gastrectomy for advanced gastric cancer. However, researchers have recently questioned the benefit of omentectomy in radical gastrectomy. The aim of this meta-analysis was to compare omentectomy and omentum preservation in gastrectomy for advanced gastric cancer in terms of survival outcomes and short-term outcomes.

Methods

The PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases were searched. Studies that compared omentum preservation with omentectomy were included. Overall survival (OS) and relapse-free survival (RFS) were analyzed as primary outcomes.

Results

Of 3509 records screened, one randomized clinical trial and five propensity-score matched retrospective studies with 1661 patients were selected. Omentum preservation was associated with improved OS (hazard ratio [HR] = 0.757, 95% confidence interval [CI] = 0.603–0.950, P = 0.016, I² = 0%), but not with improved RFS (HR = 0.821, 95% CI = 0.668–1.009, P = 0.060, I² = 9%) compared with omentectomy for advanced gastric cancer. Furthermore, less blood loss and shorter operation time were found in the omentum preservation group than in the omentectomy group. Additionally, the rate of peritoneal recurrence, the number of harvested lymph nodes, and the incidences of postoperative complications and ileus were comparable in the two groups.

Conclusions

Basing on the current literature, gastrectomy with omentum preservation was associated with improved OS and short-term outcomes compared with omentectomy for advanced gastric cancer. Further randomized trials are required to confirm the survival benefit of omentum-preserving gastrectomy.

中文翻译：

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晚期胃癌保留大网膜相对于大网膜切除术的总体生存优势：系统评价和荟萃分析

背景

自 1910 年以来，网膜切除术一直是晚期胃癌根治性胃切除术的重要组成部分。然而，研究人员最近质疑网膜切除术在根治性胃切除术中的益处。这项荟萃分析的目的是比较晚期胃癌胃切除术中网膜切除术和保留网膜的生存结果和短期结果。

方法

检索了 PubMed、Embase、Web of Science、Cochrane Central Register of Controlled Trials 和 ClinicalTrials.gov 数据库。纳入了比较保留网膜与网膜切除术的研究。总生存期（OS）和无复发生存期（RFS）被分析为主要结果。

结果

在筛选的 3509 条记录中，选择了一项随机临床试验和五项倾向评分匹配的回顾性研究，共纳入 1661 名患者。网膜保留与 OS 改善相关（风险比 [HR] = 0.757, 95% 置信区间 [CI] = 0.603–0.950, P = 0.016, I ² = 0%），但与 RFS 改善无关（HR = 0.821, 95 % CI = 0.668–1.009，P = 0.060，I ²= 9%) 与大网膜切除术治疗晚期胃癌相比。此外，与网膜切除组相比，保留网膜组的失血量更少，手术时间更短。此外，两组的腹膜复发率、收获的淋巴结数量、术后并发症和肠梗阻的发生率具有可比性。

结论

根据目前的文献，与大网膜切除术相比，保留大网膜的胃切除术与晚期胃癌的 OS 和短期结果改善相关。需要进一步的随机试验来证实保留网膜胃切除术的生存益处。