Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Oct 27, 2015; 7(10): 249-253
Published online Oct 27, 2015. doi: 10.4240/wjgs.v7.i10.249
Bursectomy at radical gastrectomy
Cuneyt Kayaalp
Cuneyt Kayaalp, Department of Surgery, Turgut Ozal Medical Center, Inonu University, 44280 Malatya, Turkey
Author contributions: Kayaalp C solely contributed to this manuscript.
Conflict-of-interest statement: Author declares no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Cuneyt Kayaalp, MD, Professor, Department of Surgery, Turgut Ozal Medical Center, Inonu University, Merkez, 44280 Malatya, Turkey.
Telephone: +90-422-3410660-3706 Fax: +90-422-3410229
Received: May 29, 2015
Peer-review started: June 1, 2015
First decision: July 25, 2015
Revised: August 3, 2015
Accepted: August 20, 2015
Article in press: August 21, 2015
Published online: October 27, 2015

Radical gastrectomy with extended lymph node dissection and prophylactic resection of the omentum, peritoneum over the posterior lesser sac, pancreas and/or spleen was advocated at the beginning of the 1960s in Japan. In time, prophylactic routine resections of the pancreas and/or spleen were abandoned because of the high incidence of postoperative complications. However, omentectomy and bursectomy continued to be standard parts of traditional radical gastrectomy. The bursa omentalis was thought to be a natural barrier against invasion of cancer cells into the posterior part of the stomach. The theoretical rationale for bursectomy was to reduce the risk of peritoneal recurrences by eliminating the peritoneum over the lesser sac, which might include free cancer cells or micrometastases. Over time, the indication for bursectomy was gradually reduced to only patients with posterior gastric wall tumors penetrating the serosa. Despite its theoretical advantages, its benefit for recurrence or survival has not been proven yet. The possible reasons for this inconsistency are discussed in this review. In conclusion, the value of bursectomy in the treatment of gastric cancer is still under debate and large-scale randomized studies are necessary. Until clear evidence of patient benefit is obtained, its routine use cannot be recommended.

Keywords: Gastric cancer, Gastrectomy, Bursectomy, Omentum, Pancreas

Core tip: Components of radical gastrectomy have decreased over time but bursectomy has been still accepted as an integral part of radical gastrectomy by Far East surgeons but not world-wide. More large-scale comparative studies are necessary to determine its benefits for cancer recurrence and patient survival. Until patient benefits are demonstrated by future studies, its routine application cannot be justified.