Bursectomy does not improve survival in resectable gastric cancer

Last Updated: 2018-05-14

By Will Boggs MD

NEW YORK (Reuters Health) - In patients with resectable gastric cancer, bursectomy does not offer a survival advantage over the less radical omentectomy, researchers from Japan report.

"We should abandon the most traditional (routinely performed) procedure in the field of gastric cancer surgery," Dr. Yukinori Kurokawa from Osaka University Graduate School of Medicine told Reuters Health by email. "The days of extended invasive surgery are over even in the treatment of gastric cancer."

Bursectomy, which involves dissection of the peritoneal lining covering the pancreas and the anterior plane of the transverse mesocolon, has been a standard procedure for resectable gastric cancer in Japan since the early 1900s. It remains unclear, however, whether bursectomy provides a survival benefit over omentectomy.

Dr. Kurokawa and colleagues compared the safety and efficacy of bursectomy versus omentectomy in their randomized, open-label phase 3 trial including 1,204 patients.

Overall, 35% of patients had total gastrectomy, and R0 resection was achieved in 93%, the team reports in The Lancet Gastroenterology & Hepatology, online April 27.

Median operation time was significantly longer for bursectomy (254 minutes) than for non-bursectomy (222 minutes) and there was greater median intraoperative blood loss with the former procedure (330 mL vs. 230 mL, respectively).

The three-year overall survival rate did not differ significantly between the non-bursectomy group (85.9%) and the bursectomy group (83.1%). Three-year relapse-free survival rates were also similar in the two groups (77.3% and 73.8%, respectively). Overall and relapse-free survival at five years did not differ, either.

Bursectomy did provide a significant five-year overall survival advantage among patients with pathological stage II tumors.

There was a trend toward better survival in the bursectomy group for patients without adjuvant chemotherapy and an opposite trend towards better survival in the non-bursectomy group for patients who had adjuvant chemotherapy.

"Our findings will accelerate the trend toward less-invasive surgery worldwide," Dr. Kurokawa concluded.

"Although some biases and cautions exist regarding its external validity, we think these are unlikely to have significantly compromised the trial result, or its relevance internationally," write Dr. Ben E. Byrne and colleagues from the University of Bristol, U.K., in an accompanying editorial. "This trial ought, therefore, to shape practice internationally, promoting a shift away from bursectomy during gastrectomy for gastric cancer while retaining the current gold standard practice of radical D2 lymphadenectomy."

SOURCE: https://bit.ly/2KYXGpJ and https://bit.ly/2IBaUdR

Lancet Gastroenterol Hepatol 2018.