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  • Bursectomy not a...

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

Written By : Dr.Niharika Harsha B |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2023-01-04T09:45:00+05:30  |  Updated On 4 Jan 2023 2:34 PM IST
Bursectomy not a recommended standard procedure for cT3-T4a gastric cancer
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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.

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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.
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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

Bursectomybursa omentalisgastrectomygastric canceromentectomyadenocarcinomacT3–T4aD2 gastrectomyintention-to-treat basis
Source : British Journal of Surgery
Dr.Niharika Harsha B
Dr.Niharika Harsha B

    BDS, MDS

    Dr.Niharika Harsha B (BDS,MDS) completed her BDS from Govt Dental College, Hyderabad and MDS from Dr.NTR University of health sciences(Now Kaloji Rao University). She has 4 years of private dental practice and worked for 2 years as Consultant Oral Radiologist at a Dental Imaging Centre in Hyderabad. She worked as Research Assistant and scientific writer in the development of Oral Anti cancer screening device with her seniors. She has a deep intriguing wish in writing highly engaging, captivating and informative medical content for a wider audience. She can be contacted at editorial@medicaldialogues.in.

    Dr. Kamal Kant Kohli
    Dr. Kamal Kant Kohli

    Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751

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