Pankaj Kumar Garg1, Ashish Jakhetiya2, Kiran Kalyan Turaga3, Rahul Kumar4, Andreas Brandl5, Beate Rau6. 1. Department of Surgical Oncology, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, India. 2. Department of Surgical Oncology, Geetanjali Medical College and Hospital, Udaipur, India. 3. Section of Surgery and Surgical Oncology, Department of Surgery, The University of Chicago Medicine, Chicago, Illinois, USA. 4. Department of Surgical Oncology, All India Institute of medical Sciences, Rishikesh, India. 5. Digestive Unit, Champalimaud Foundation, Lisbon, Portugal. 6. Department of Surgery, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Abstract
BACKGROUND: Resection of the omental bursa has been suggested to reduce peritoneal recurrence and facilitate a complete oncological resection during a gastrectomy. The addition of this procedure increases technical complexity and prolongs the procedure. Published data regarding the oncological benefit of this procedure are conflicting. We hypothesized that a bursectomy during a radical gastrectomy does not improve overall survival. METHODS: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline, a comprehensive literature search of 3 electronic databases (PubMed, Scopus, and Embase) was conducted to identify the clinical studies that compared bursectomy with no-bursectomy in radical gastrectomy for gastric adenocarcinoma. Qualitative and quantitative data synthesis was performed using RevMan software. A random-/fixed-effect modeling was used depending upon the heterogeneity. Bias and quality assessment tools were applied. The study was registered with the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42019116556). RESULTS: Of 8 studies assessing the role of bursectomy in gastric adenocarcinoma, 6 (75%) were included - of which 2 (33%) are randomized controlled trials. Of 2,904 patients, 1,273 (%) underwent a bursectomy. There was no statistically significant difference in either overall survival (hazard ratio [HR] = 0.89, 95% CI 0.75-1.06, I2 = 14%) or disease recurrence (HR = 1.01, 95% CI 0.84-1.20, I2 = 22%) in the bursectomy group compared to the no-bursectomy group. CONCLUSION: There is no additional oncological benefit of adding bursectomy to radical gastrectomy in all patients with gastric adenocarcinoma.
BACKGROUND: Resection of the omental bursa has been suggested to reduce peritoneal recurrence and facilitate a complete oncological resection during a gastrectomy. The addition of this procedure increases technical complexity and prolongs the procedure. Published data regarding the oncological benefit of this procedure are conflicting. We hypothesized that a bursectomy during a radical gastrectomy does not improve overall survival. METHODS: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline, a comprehensive literature search of 3 electronic databases (PubMed, Scopus, and Embase) was conducted to identify the clinical studies that compared bursectomy with no-bursectomy in radical gastrectomy for gastric adenocarcinoma. Qualitative and quantitative data synthesis was performed using RevMan software. A random-/fixed-effect modeling was used depending upon the heterogeneity. Bias and quality assessment tools were applied. The study was registered with the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42019116556). RESULTS: Of 8 studies assessing the role of bursectomy in gastric adenocarcinoma, 6 (75%) were included - of which 2 (33%) are randomized controlled trials. Of 2,904 patients, 1,273 (%) underwent a bursectomy. There was no statistically significant difference in either overall survival (hazard ratio [HR] = 0.89, 95% CI 0.75-1.06, I2 = 14%) or disease recurrence (HR = 1.01, 95% CI 0.84-1.20, I2 = 22%) in the bursectomy group compared to the no-bursectomy group. CONCLUSION: There is no additional oncological benefit of adding bursectomy to radical gastrectomy in all patients with gastric adenocarcinoma.
Authors: Michael D'Angelica; Mithat Gonen; Murray F Brennan; Alan D Turnbull; Manjit Bains; Martin S Karpeh Journal: Ann Surg Date: 2004-11 Impact factor: 12.969