Metastasis in lymph nodes on the anterior pancreatic surface of the body and tail: an extremely rare finding during bursectomy in extended surgery for gastric cancer

The role of bursectomy in the surgical management of gastric cancer: a meta-analysis and systematic review

In order to delineate the exact role of bursectomy (BS) in gastric cancer surgery, we designed and conducted the present meta-analysis. This meta-analysis adhered to the PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. A systematic literature review of the electronic databases (Medline, Scopus, Web of Science) was performed. Trial sequential analysis (TSA) was introduced for the validation of the pooled analyses. The level of evidence was attributed based on the GRADE approach. Overall, nine studies and 3599 patients were included in our meta-analysis. BS did not lead to an increase in the overall morbidity rate (OR 1.17, 95% CI 0.97-1.42, p = 0.09). Equivalence was, also, identified in all specific postoperative complications. Similarly, mortality rates were comparable (p = 0.69). Moreover, BS was related to a significantly higher operative time (p < 0.001) and perioperative blood loss (p = 0.002). Finally, resection of the omental bursa was not associated with improved R0 excision rates (p = 0.92), lymph node harvest (p = 0.1) or survival outcomes (OS p = 0.15 and DFS p = 0.97). BS displayed a suboptimal perioperative performance without any significant oncological efficacy. Due to certain limitations and the low level of evidence, further high-quality RCTs are required.

Bursectomy Versus Nonbursectomy for Gastric Adenocarcinoma: A Single-Center, Propensity-Score Matched Cohort Study in China

Background: The therapeutic value of bursectomy remains controversial for patients with gastric cancer. Therefore, the purpose of our study was to explore the safety and survival benefits of bursectomy. Materials and Methods: A total of 943 patients with gastric adenocarcinoma were included in our study, and all patients were operated on by high-quality gastrointestinal surgeons. The factors associated with overall survival (OS) were determined using the Kaplan-Meier method. In addition, patients in the bursectomy group and nonbursectomy group were matched with 1:1 propensity score matching for sex, age, tumor location, type of operation, tumor size, degree of differentiation, and pathological stage to reduce the possibility of choice bias. Results: Among the 943 eligible patients, 188 (19.9%) underwent bursectomy and 755 (80.1%) did not. In all patients, the number of retrieved lymph nodes (P = .0596), blood loss volume (P = .0896), operation time (P = .0747), number of postoperative complications (P = .626), and OS in the bursectomy group were similar to those in the nonbursectomy group. After a stratified analysis of TNM grade and T stage, it was found that bursectomy could lead to survival benefits for patients with stage T4 disease (P = .0398). Conclusions: Bursectomy does not increase the amount of blood loss, operation time, or incidence of postoperative complications. This procedure is an extended and safe surgical method for gastric adenocarcinoma. Bursectomy does not improve the survival of all patients, but for patients with stage T4 disease, bursectomy can provide survival benefits.

Bursectomy and non-bursectomy D2 gastrectomy for advanced gastric cancer, initial experience from a single institution in China

BACKGROUND

The aim of this study is to evaluate the safety and efficacy of bursectomy of D2 gastrectomy in terms of postoperative complications and short-term survival outcomes.

METHODS

From January 2012 to December 2013, data of 406 gastric cancer patients with advanced tumor stages and who underwent D2 radical gastrectomy and were grouped according to whether bursectomy was performed or not in West China Hospital, Sichuan University, were analyzed.

RESULTS

Finally, 159 patients were in bursectomy group and 247 patients in non-bursectomy group. Surgical duration was 260.1 ± 43.4 min in the bursectomy group, compared to 227.9 ± 48.6 min in the non-bursectomy group (p < 0.001). The intraoperative blood loss was comparable between the bursectomy group and the non-bursectomy group (198.9 ± 63.5 vs. 201.1 ± 53.7 ml, p = 0.729). Postoperative morbidity rate showed no significant difference between the two groups, which were 23.3 % in the bursectomy group and 17.8 % in the non-bursectomy group, p = 0.179. The overall survival outcomes of patients were compared between the two groups of all patients (p = 0.055): patients who underwent distal gastrectomy (p = 0.129) and total gastrectomy (p = 0.016) and pT2-3 stage patients (p = 0.117) and pT4a stage patients (p = 0.128). The multivariate survival analysis identified that bursectomy or not, pT stage and pN stage were independent prognostic risk factors for the overall survival.

CONCLUSIONS

The bursectomy might increase the surgical duration when the D2 gastrectomy was done. Experienced surgeons can perform it safely. However, for the survival benefits of bursectomy, long-term, large sample sized, and high-quality randomized controlled trials are expected.