Partial Versus Total Omentectomy in Patients with Gastric Cancer: A Systemic Review and Meta-Analysis

SIMPLE SUMMARY: Gastric cancer is one of the leading causes of cancer-related mortality, especially in Asia. Radical gastrectomy, including omentectomy, is the standard surgical procedure for curative treatment. Nevertheless, total omentectomy may have an impact on postoperative complications. Although the omentum serves as a bridge for peritoneal metastasis, some clinicians propose that the omentum could participate in anti-bacterial defense, hemostasis, and prevention of intestinal adhesions. Clinically, it is controversial whether extensive omentectomy provides better survival to patients. Here, we conducted a systematic review and meta-analysis to investigate the safety and efficacy of partial omentectomy compared to total omentectomy during radical gastrectomy in patients with gastric cancer. We demonstrate that partial omentectomy has non-inferior long-term oncological outcomes compared to total omentectomy. In addition, partial omentectomy is associated with shorter operative time and lesser blood loss. Therefore, it may not be necessary to perform total omentectomy routinely. ABSTRACT: Background: Surgical treatment is the key to cure localized gastric cancer. There is no strong evidence that supports the value of omentectomy. Thus, a meta-analysis was conducted to compare the safety and efficiency of partial and total omentectomy in patients with gastric cancer. Methods: PubMed, Embase, and Cochrane Library databases were searched. All studies that compared total and partial omentectomy as treatments for gastric cancer were included. The primary outcomes were patients’ overall survival and disease-free survival, while the secondary outcomes were perioperative outcome and postoperative complications. Results: A total of nine studies were examined, wherein 1043 patients were included in the partial omentectomy group, and 1995 in the total omentectomy group. The partial omentectomy group was associated with better overall survival (hazard ratio: 0.80, 95% CI: 0.66 to 0.98, p = 0.04, I(2) = 0%), shorter operative time, and lesser blood loss than the total omentectomy group. In addition, no statistically significant difference was observed in the number of dissected lymph nodes, length of hospital stays, complication rate, and disease-free survival. Conclusions: Our results show that, compared with total omentectomy in gastric cancer surgery, partial omentectomy had non-inferior oncological outcomes and comparable safety outcomes.