Current debate in gastric cancer surgery: Omentectomy?

Despite the advancement of technology and neoadjuvant/adjuvant chemotherapy, molecular targeted agents, gastrectomy, and D2 lymph node dissection are the only curative treatment option for advanced gastric cancer (GC). The most common sites of recurrence in patients with GC are the peritoneum and omentum. The omentum contains areas rich in lymphatic tissue (the milky area) that form the connection between the peritoneum and the lymphatic system. Tumor cells are often found in these areas. Therefore, omentectomy is added to radical gastric resection and modified D2 lymph node dissection in the treatment of GC. Total omentectomy is recommended by Western countries for GC diagnosed at T3-4 stage, while Japanese research suggests partial omentectomy at T1-2 stage and total omentectomy at T3-4 stage due to early diagnosis of GC. In addition to the differences in tumor biology, the fact that patients in Western countries are more likely to receive perioperative chemotherapy and the 5% incidence of omental metastasis in advanced disease has led to the belief that partial omentectomy is an adequate surgical procedure compared with total omentectomy. There are studies recommending total omentectomy for the removal of possible tumor foci, and there are some studies reporting that partial omentectomy is sufficient even in advanced GC. The aim of this review was to investigate whether total or partial omentectomy should be performed in patients with GC.