Omentectomy with Gastrectomy for Gastric Cancer - Dilemma or Disease Demand? The STOMEC Study

The omentum plays a valuable protective role post abdominal surgeries. Our goal was to determine the presence of metastatic omental lymph nodes or tumour deposits in stage I-III gastric adenocarcinoma, thus defining patterns of factors predictive of greater omental disease, which may contribute to omental sparing. Specimens of 115 patients with gastric adenocarcinoma stages I - III, operated consecutively, were analysed. The greater omentum was sent after separating it at 3 cm from the gastro - epiploic arcade. The number of total retrieved and metastatic lymph nodes in the greater omentum and the presence of tumour deposits, signet ring cell histology, and lympho-vascular invasion (LVI) of the primary tumour were noted. All calculations were carried out with IBM SPSS Statistics version 21.0. The Fisher exact chi-square test was done to evaluate the significance of association between the data, and a p-value ≤ 0.05 was considered to be significant. In total, 17.4% of patients had signet ring cell histology. A total of 34.8% were at pathological stage III. LVI was present in 25.2%. Two out of 115 patients (1.7%) had metastatic greater omental nodes, both of which were at stage III, signet ring cell histology, and LVI +ve. There was a significant association between malignant omental nodes, stage III disease, and signet ring cell type, while the association with LVI neared statistical significance. Irrespective of stage, the presence of omental disease in gastric adenocarcinoma is rare and may have a pattern of predictive features in its histology and stage, and thus set the stage for omental-sparing surgery in gastric cancer.