Omentectomy Versus Omental Preservation During Gastrectomy for Gastric Cancer: Systematic Review and Reconstructed Individual Patient Data Meta-Analysis
6 affiliations
- 1Division of General Surgery, I.R.C.C.S. Ospedale Galeazzi—Sant’Ambrogio, 20151 Milan, Italy
- 2Regional Institute of Gastroenterology and Hepatology O. Fodor Cluj-Napoca, University of Medicine and Pharmacy Iuliu Hatieganu Cluj-Napoca, Croitorilor 19-21, 400162 Cluj-Napoca-Napoca, Romania
- 3Galeazzi-Sant’Ambrogio Hospital, University of Insubria, 20157 Milan, Italy
- 4G. Rodolico Hospital, Surgical Division, Department of General Surgery and Medical Surgical Specialties, University of Catania, 95131 Catania, Italy
- 5Department of Pharmacy, Health and Nutrition Sciences, Azienda Ospedaliera di Cosenza, Division of General and Foregut Surgery, University of Calabria, 87036 Cosenza, Italy
- 6Department of Biomedical Science for Health, University of Milan, 20157 Milan, Italy
Abstract
Background/Objectives: The oncological benefit of routine omentectomy (OmR) during curative gastrectomy for gastric cancer (GC) remains controversial. While omentectomy has traditionally been performed to reduce peritoneal dissemination, the greater omentum also possesses immunological functions that may protect against tumor implantation. This study evaluated the impact of OmR versus omental preservation (OmP) on long-term survival using reconstructed individual patient data (IPD) and restricted mean survival time difference (RMSTD) meta-analysis. Methods: A systematic review was conducted according to PRISMA 2020 guidelines. Comparative studies reporting Kaplan–Meier curves for overall survival (OS) and/or disease-free survival (DFS) after OmR versus OmP were included. IPD were reconstructed from published survival curves, and pooled RMSTD estimates were calculated using random-effects multivariate meta-analysis. Flexible hazard-based regression models assessed time-varying treatment effects. Secondary outcomes included postoperative morbidity and operative outcomes. Results: Fifteen studies involving 5325 patients were included, of whom 54% underwent OmR. At 60 months, no significant difference in OS was observed for OmR vs. OmP (−0.79 months, 95% CI −2.13 to 0.54). Similarly, DFS did not differ significantly (−2.12 months, 95% CI −4.59 to 0.35). Time-varying hazard analyses demonstrated no survival advantage for OmR throughout follow-up. OmR was associated with significantly higher intraoperative blood loss (MD 42.9), overall complications (RR 1.17), and longer hospital length of stay (MD 0.49). Retrieved lymph nodes, anastomotic leak, operative time, and 30-day mortality were comparable. Conclusions: In this study, routine omentectomy during gastrectomy for gastric cancer was not associated with improved OS or DFS compared with omental preservation. These findings question the need for routine omentectomy and suggest that omental preservation may represent a reasonable surgical strategy in selected patients, pending confirmation from prospective randomized trials.
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BibTeX
@article{aiolfi2026omentectomy,
title = {{Omentectomy Versus Omental Preservation During Gastrectomy for Gastric Cancer: Systematic Review and Reconstructed Individual Patient Data Meta-Analysis}},
author = {Alberto Aiolfi and Antonio Farro and Matteo Calì and Francesco Cammarata and Calin Popa and Gianluca Bonitta and Marta Cavalli and Giampiero Campanelli and Antonio Biondi and Luigi Bonavina and Davide Bona},
journal = {Journal of Clinical Medicine},
year = {2026},
month = nov,
doi = {10.3390/jcm15218495},
url = {https://www.mdpi.com/2077-0383/15/21/8495},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Omentectomy Versus Omental Preservation During Gastrectomy for Gastric Cancer: Systematic Review and Reconstructed Individual Patient Data Meta-Analysis
AU - Alberto Aiolfi
AU - Antonio Farro
AU - Matteo Calì
AU - Francesco Cammarata
AU - Calin Popa
AU - Gianluca Bonitta
AU - Marta Cavalli
AU - Giampiero Campanelli
AU - Antonio Biondi
AU - Luigi Bonavina
AU - Davide Bona
PY - 2026
DA - 2026/11/01
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218495
UR - https://www.mdpi.com/2077-0383/15/21/8495
AB - Background/Objectives: The oncological benefit of routine omentectomy (OmR) during curative gastrectomy for gastric cancer (GC) remains controversial. While omentectomy has traditionally been performed to reduce peritoneal dissemination, the greater omentum also possesses immunological functions that may protect against tumor implantation. This study evaluated the impact of OmR versus omental preservation (OmP) on long-term survival using reconstructed individual patient data (IPD) and restricted mean survival time difference (RMSTD) meta-analysis. Methods: A systematic review was conducted according to PRISMA 2020 guidelines. Comparative studies reporting Kaplan–Meier curves for overall survival (OS) and/or disease-free survival (DFS) after OmR versus OmP were included. IPD were reconstructed from published survival curves, and pooled RMSTD estimates were calculated using random-effects multivariate meta-analysis. Flexible hazard-based regression models assessed time-varying treatment effects. Secondary outcomes included postoperative morbidity and operative outcomes. Results: Fifteen studies involving 5325 patients were included, of whom 54% underwent OmR. At 60 months, no significant difference in OS was observed for OmR vs. OmP (−0.79 months, 95% CI −2.13 to 0.54). Similarly, DFS did not differ significantly (−2.12 months, 95% CI −4.59 to 0.35). Time-varying hazard analyses demonstrated no survival advantage for OmR throughout follow-up. OmR was associated with significantly higher intraoperative blood loss (MD 42.9), overall complications (RR 1.17), and longer hospital length of stay (MD 0.49). Retrieved lymph nodes, anastomotic leak, operative time, and 30-day mortality were comparable. Conclusions: In this study, routine omentectomy during gastrectomy for gastric cancer was not associated with improved OS or DFS compared with omental preservation. These findings question the need for routine omentectomy and suggest that omental preservation may represent a reasonable surgical strategy in selected patients, pending confirmation from prospective randomized trials.
SN - 2077-0383
ER -