title: Is bursectomy necessary for patients with gastric cancer invading the serosa?
abstract: OBJECTIVE
  To confirm the impact of bursectomy on survival, we reviewed the clinical records of patients who underwent radical total gastrectomy with bursectomy for gastric cancer invading the serosa, with special reference to the location of tumor invasion.
  
  
  METHODS
  From the records, patients were selected for this retrospective cohort study according to the following criteria: (a) Invasion beyond the serosal surface, (b) No metastases to liver, peritoneum, or distant organs, (c) Negative for peritoneal lavage cytology, and (d) Patients underwent curative D2 total gastrectomy with complete omental bursectomy. A total of 134 patients were eligible. These patients were divided into a group I which included patients with tumors that invaded only the posterior wall and a group II which included those with others. Survival was examined by uni- and multivariate analyses.
  
  
  RESULTS
  Survival rates at 3 and 5 years were 67.3% and 53.0% for group I and 68.8% and 53.8% for group II. There was no significant difference in the survival between the two groups (p=0.969), even if survival was stratified by various clinicopathological factors. Multivariate analyses demonstrated that the significant independent factors for the survival were macroscopic type and lymph node metastasis. Location of the invasion was not a significant factor.
  
  
  CONCLUSIONS
  These results suggested that bursectomy did not inhibit the spreading of tumor cells into the retro-stomach space. There might be no survival benefit of bursectomy in patients with gastric cancer.
authors.affiliation: Department of Gastrointestinal Surgery, Kanagawa Cancer Center Hospital, Yokohama, Japan.
authors.forename: Takaki
authors.initials: T
authors.lastname: Yoshikawa
authors.forename: Akira
authors.initials: A
authors.lastname: Tsuburaya
authors.forename: Osamu
authors.initials: O
authors.lastname: Kobayashi
authors.forename: Motonori
authors.initials: M
authors.lastname: Sairenji
authors.forename: Hisahiko
authors.initials: H
authors.lastname: Motohashi
authors.forename: Shinichi
authors.initials: S
authors.lastname: Hasegawa
authors.forename: Naoki
authors.initials: N
authors.lastname: Ishiwa
authors.forename: Soichiro
authors.initials: S
authors.lastname: Morinaga
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Noguchi
authors.forename: Yuji
authors.initials: Y
authors.lastname: Yamamoto
authors.forename: Akihiko
authors.initials: A
authors.lastname: Matsumoto
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D015331:Cohort Studies; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D010529:Peritoneal Cavity / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012704:Serous Membrane / Q000473:pathology; D013270:Stomach / Q000473:pathology; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis; D015996:Survival Rate