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TOTAL OMENTECTOMY IN GASTRIC CANCER SURGERY: IS IT ALWAYS NECESSARY?

BACKGROUND: Traditionally, total omentectomy is performed along with gastric resection and extended lymphadenectomy in gastric cancer (GC) surgery. However, solid evidences regarding its oncologic benefit is still scarce. AIM: To evaluate the incidence of metastatic omental lymph nodes (LN) in patie...

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Detalles Bibliográficos
Autores principales: BARCHI, Leandro Cardoso, RAMOS, Marcus Fernando Kodama Pertille, DIAS, André Roncon, YAGI, Osmar Kenji, RIBEIRO-JÚNIOR, Ulysses, ZILBERSTEIN, Bruno, CECCONELLO, Ivan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Colégio Brasileiro de Cirurgia Digestiva 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6368152/
https://www.ncbi.nlm.nih.gov/pubmed/30758473
http://dx.doi.org/10.1590/0102-672020180001e1425
Descripción
Sumario:BACKGROUND: Traditionally, total omentectomy is performed along with gastric resection and extended lymphadenectomy in gastric cancer (GC) surgery. However, solid evidences regarding its oncologic benefit is still scarce. AIM: To evaluate the incidence of metastatic omental lymph nodes (LN) in patients undergoing curative gastrectomy for GC, as well as its risk factors and patients’ outcomes. METHODS: All consecutive patients submitted to D2/modified D2 gastrectomy due to gastric adenocarcinoma from March 2009 to April 2016 were retrospectively reviewed from a prospective collected database. RESULTS: Of 284 patients included, five (1.8%) patients had metastatic omental LN (one: pT3N3bM0; two: pT4aN3bM0; one: pT4aN2M0 and one pT4bN3bM0). Four of them deceased and one was under palliative chemotherapy due relapse. LN metastases in the greater omentum significantly correlated with tumor’s size (p=0.018), N stage (p<0.001), clinical stage (p=0.022), venous invasion growth (p=0.003), recurrence (p=0.006), site of recurrence (peritoneum: p=0.008; liver: p=0.023; ovary: p=0.035) and death (p=0.008). CONCLUSION: The incidence of metastatic omental LN of patients undergoing radical gastrectomy due to GC is extremely low. Total omentectomy may be avoided in tumors smaller than 5.25 cm and T1/T2 tumors. However, the presence of lymph node metastases in the greater omentum is associated with recurrence in the peritoneum, liver, ovary and death.