Bursectomy not a recommended standard procedure for cT3-T4a gastric cancer

Japan Researchers found that bursectomy is not a recommended standard procedure for cT3-T4a gastric cancer in D2 gastrectomy in their phase III trial. The Trial results were published in the British Journal of Surgery.  

A routine standard procedure in gastrectomy for resectable gastric cancer is the bursectomy where the total resection of the bursa omentalis is done. Researchers from various centers in Japan carried out a phase III trial (JCOG1001) comparing bursectomy and omentectomy alone. It was terminated early at the interim analysis and the final results of the updated analysis after a minimum follow-up of 5 years were reported by the researchers. 

A multicenter randomized trial was carried out on patients with histologically proven adenocarcinoma of the stomach (cT3–T4a) between June 2010 and March 2015. They were randomized (1: 1) during surgery to bursectomy or omentectomy-alone groups and then underwent D2 gastrectomy. Nearly 1204 patients were randomized to the two groups having 602 patients in each. The primary endpoint was overall survival. The intention-to-treat basis was used to analyze the overall survival.

The key findings of the study were: 

• A significantly higher incidence of Clavien–Dindo grade III–IV intra-abdominal abscess was seen in the bursectomy group than in the omentectomy-alone group (5.5 versus 2.5 percent respectively; P = 0.008).
• The updated 5-year overall survival rates were 74.9% in the bursectomy group and 76.5% in the omentectomy-alone group.
• The adjusted HR for death in the bursectomy group was 1.03 (1-sided P = 0.598).
• Peritoneal recurrence was not decreased by Bursectomy (12.1 versus 12.3 percent respectively; P = 1.000).
• In a multivariable analysis, old age (above 65 years), tumor located in the lower third or posterior wall of the stomach, macroscopic type 3/5, total gastrectomy, and cT4a were independent predictors of poor overall survival, but omentectomy alone was not.

Thus, bursectomy was not recommended as a standard procedure for cT3–T4a gastric cancer in D2 gastrectomy as it did not provide a survival advantage. 

Further reading: Kurokawa Y, Doki Y, Mizusawa J, et al. Five-year follow-up of a randomized clinical trial comparing bursectomy and omentectomy alone for resectable gastric cancer (JCOG1001) [published online ahead of print, 2022 Nov 12]. Br J Surg. 2022;znac373. doi: 10.1093/bjs/znac373