Abstract：
BACKGROUND: Omentectomy has been traditionally a part of standard radical gastrectomy. Its clinical benefit for locally advanced gastric cancer (LAGC) remains controversial. This study aimed at evaluating the impact of gastrectomy with omentum preservation (GOP) on survival, recurrence, surgical outcomes and postoperative complications by comparing with gastrectomy with omentum resection (GOR).
METHODS: Original studies comparing GOP with GOR in LAGC were searched. Meta-analysis was performed using RevMan 5.4.
RESULTS: Seven studies involving 1879 patients were analyzed. Compared with GOR, GOP achieved significantly better overall survival (HR = 0.75 [0.60, 0.95], P = 0.01), with similar relapse-free survival (HR = 0.84 [0.68, 1.03], P = 0.10). The two groups had similar total recurrence rate (OR = 0.86 [0.68, 1.08], P = 0.19) and no significant differences in rates of peritoneal, hematogenous, locoregional or distant lymph node recurrences. GOP had significantly less blood loss (MD = -83 [-139, -28] ml, P = 0.003) and tended to have shorter operation time (MD = -28 [-58, 2] min, P = 0.06), with similar harvested number of lymph nodes (MD = -0.4 [-2.6, 1.8], P = 0.70). The incidences of total all grade and major complications were similar in GOP and GOR (all grade: 31.8% vs. 30.3%, OR = 1.08 [0.79, 1.46], P = 0.64; major: 9.2% vs. 10.1%, OR = 1.14 [0.55, 2.34], P = 0.73). There were no significant differences in incidences of complication or postoperative mortality.
CONCLUSIONS: Omentum preservation did not affect curability or survival in LAGC. These findings require validation in randomized controlled trials with large sample sizes.
METHODS: Original studies comparing GOP with GOR in LAGC were searched. Meta-analysis was performed using RevMan 5.4.
RESULTS: Seven studies involving 1879 patients were analyzed. Compared with GOR, GOP achieved significantly better overall survival (HR = 0.75 [0.60, 0.95], P = 0.01), with similar relapse-free survival (HR = 0.84 [0.68, 1.03], P = 0.10). The two groups had similar total recurrence rate (OR = 0.86 [0.68, 1.08], P = 0.19) and no significant differences in rates of peritoneal, hematogenous, locoregional or distant lymph node recurrences. GOP had significantly less blood loss (MD = -83 [-139, -28] ml, P = 0.003) and tended to have shorter operation time (MD = -28 [-58, 2] min, P = 0.06), with similar harvested number of lymph nodes (MD = -0.4 [-2.6, 1.8], P = 0.70). The incidences of total all grade and major complications were similar in GOP and GOR (all grade: 31.8% vs. 30.3%, OR = 1.08 [0.79, 1.46], P = 0.64; major: 9.2% vs. 10.1%, OR = 1.14 [0.55, 2.34], P = 0.73). There were no significant differences in incidences of complication or postoperative mortality.
CONCLUSIONS: Omentum preservation did not affect curability or survival in LAGC. These findings require validation in randomized controlled trials with large sample sizes.
摘要：
背景：传统上，网膜切除术一直是标准胃癌根治术的一部分。其对局部晚期胃癌（LAGC）的临床益处仍存在争议。本研究旨在评估胃切除术与网膜保存（GOP）对生存的影响，复发,通过与胃切除术和网膜切除术（GOR）的比较，手术效果和术后并发症。
方法：搜索了LAGC中比较GOP和GOR的原始研究。采用RevMan5.4进行Meta分析。
结果：分析了涉及1879名患者的7项研究。与GOR相比,GOP获得了显著更好的总生存期(HR=0.75[0.60,0.95]，P=0.01),无复发生存率相似(HR=0.84[0.68,1.03]，P=0.10）。两组总复发率相似(OR=0.86[0.68,1.08],P=0.19），腹膜发生率无显着差异，血源性，局部或远处淋巴结复发。GOP的失血量明显减少（MD=-83[-139，-28]ml，P=0.003），并且倾向于具有较短的手术时间（MD=-28[-58，2]min，P=0.06),淋巴结收集数量相似(MD=-0.4[-2.6，1.8]，P=0.70）。GOP和GOR中所有级别和主要并发症的总发生率相似(所有级别：31.8%与30.3%,OR=1.08[0.79，1.46]，P=0.64；主要：9.2％vs.10.1%,OR=1.14[0.55，2.34]，P=0.73）。并发症发生率和术后死亡率无显著差异。
结论：网膜保存不影响LAGC的可固化性或存活率。这些发现需要在大样本量的随机对照试验中进行验证。
方法：搜索了LAGC中比较GOP和GOR的原始研究。
结果：分析了涉及1879名患者的7项研究。
结论：网膜保存不影响LAGC的可固化性或存活率。
