Omentectomy and Gastrectomy Strategies in Gastric Cancer Management
Summary
The combination of gastrectomy and omentectomy remains central to curative treatment of gastric adenocarcinoma. Gastrectomy may be total or subtotal and is accompanied by systematic lymphadenectomy to address regional nodal spread. The greater omentum is often excised because it can harbour microscopic tumour deposits and facilitate peritoneal dissemination via specialised immune cell aggregates known as omental milky spots. However, the oncological value of complete versus partial omentectomy has been questioned, prompting investigation of omentum-preserving approaches. Technological advances in minimally invasive surgery, improved preoperative imaging and machine-learning risk stratification are enabling more individualised operative planning. Concurrently, experimental studies have elucidated the molecular crosstalk between omental adipocytes, immune niches and gastric tumour cells, highlighting the omentum’s role as both a surgical target and a biological mediator of metastasis.
Research from Nature Portfolio
Recent studies have explored predictive modelling of omental metastases and long-term outcomes of omentum-preserving surgery. One report described the use of machine learning to extract radiomic features from contrast-enhanced CT scans and build models such as random forests and support vector machines to predict omental involvement in locally advanced gastric cancer. The random forest classifier achieved superior accuracy and positive predictive value across training and validation cohorts, suggesting that radiomic signatures may guide the extent of omentectomy. Another investigation employed propensity score matching to compare three-year survival and recurrence patterns in patients undergoing gastrectomy with omentum preservation versus complete omentectomy. No significant differences were observed in overall or relapse-free survival, rates of peritoneal carcinomatosis or postoperative complications, indicating that sparing the omentum may be oncologically safe in selected advanced cases.
Omentectomy and Gastrectomy Strategies in Gastric Cancer Management publication trend
The graph below shows the total number of articles in omentectomy and gastrectomy strategies in gastric cancer management across all publications each year (not limited to Nature Index journals).
Technical terms
Omentectomy: Surgical removal of the greater omentum, performed to eliminate potential peritoneal metastasis sites.
Gastrectomy: Surgical resection of part (subtotal) or all (total) of the stomach as definitive treatment for gastric cancer.
Radiomic features: Quantitative image-derived metrics capturing tumour shape, texture and intensity patterns for predictive modelling.
Propensity score matching: Statistical technique used in observational studies to balance covariates between treatment groups and reduce bias.
Peritoneal dissemination: Spread of cancer cells throughout the peritoneal cavity, leading to metastatic implants on serosal surfaces.
References
- Characteristics and clinical significance of immune cells in omental milky spots of patients with gastric cancer. Frontiers in Immunology (2025).
- Comparative assessment of the capability of machine learning-based radiomic models for predicting omental metastasis in locally advanced gastric cancer. Scientific Reports (2024).
- Omental adipocytes promote peritoneal metastasis of gastric cancer through the CXCL2–VEGFA axis. British Journal of Cancer (2020).
- The Oncological Value of Omentectomy in Gastrectomy for Cancer. Journal of Gastrointestinal Surgery (2016).
- Long-term outcomes of omentum-preserving versus resecting gastrectomy for locally advanced gastric cancer with propensity score analysis. Scientific Reports (2020).
- Lymph Node Dissection in Curative Gastrectomy for Advanced Gastric Cancer. International Journal of Surgical Oncology (2011).
- Efficacy of Omentum-Preserving Gastrectomy for Patients With Gastric Cancer: A Systematic Review and Meta-Analysis. Frontiers in Oncology (2021).
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