Ilhan E, Yildirim M. Current debate in gastric cancer surgery: Omentectomy? World J Gastrointest Surg 2025; 17(8): 108110 [DOI: 10.4240/wjgs.v17.i8.108110]
Corresponding Author of This Article
Enver Ilhan, Full Professor, Department of General Surgery, University of Health Sciences Turkey, Izmir Faculty of Medicine, Izmir City Hospital, Şevket İnce 2148/11. Street, İzmir 35530, Türkiye. enverhan60@gmail.com
Research Domain of This Article
Surgery
Article-Type of This Article
Minireviews
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Aug 27, 2025; 17(8): 108110 Published online Aug 27, 2025. doi: 10.4240/wjgs.v17.i8.108110
Current debate in gastric cancer surgery: Omentectomy?
Enver Ilhan, Mehmet Yildirim
Enver Ilhan, Mehmet Yildirim, Department of General Surgery, University of Health Sciences Turkey, Izmir Faculty of Medicine, Izmir City Hospital, İzmir 35530, Türkiye
Author contributions: Ilhan E conceived the idea and contributed to writing the paper; Yildirim M reviewed the literature; All authors read and approved the final version of the manuscript.
Conflict-of-interest statement: There are no conflicts of interest associated the authors.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Enver Ilhan, Full Professor, Department of General Surgery, University of Health Sciences Turkey, Izmir Faculty of Medicine, Izmir City Hospital, Şevket İnce 2148/11. Street, İzmir 35530, Türkiye. enverhan60@gmail.com
Received: April 7, 2025 Revised: April 25, 2025 Accepted: July 1, 2025 Published online: August 27, 2025 Processing time: 142 Days and 17.1 Hours
Abstract
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.
Core Tip: Omentectomy is used to remove tumor cells or tumor deposits in gastrectomy for gastric cancer. However, it has not been shown to improve survival and is associated with perioperative problems. For this reason partial omentectomy or omentum preservation has been used in recent years.
