title: Role of bursectomy for advanced gastric cancer: result of a case-control study from a large volume hospital.
abstract: OBJECTIVE
  According to the recent Japanese Gastric Cancer Association's gastric cancer treatment guidelines, bursectomy is recommended for tumors penetrating the serosa of the posterior gastric wall. However, there is still little data to show whether bursectomy improves patient survival. The aim of this study is to evaluate the efficacy of bursectomy for subserosa or serosa-positive gastric cancer in terms of overall survival.
  
  
  METHODS
  From April 2001 to December 2006, 470 patients underwent curative resection for macroscopically subserosa or serosa-positive gastric cancer. These patients were grouped according to whether bursectomy was performed or not (bursectomy+/bursectomy-). Clinicopathological characteristics and incidence of complications were compared between the groups. The overall survival rates were analyzed using a Cox proportional hazards model.
  
  
  RESULTS
  There was no significant difference in morbidity and mortality between the bursectomy+ and bursectomy- groups. In the multivariable analysis for overall survival, bursectomy was not a significant independent factor (p = 0.978). In the subgroup analysis for clinical and pathological stage III and IV, and tumors penetrating the serosa of the posterior gastric wall, bursectomy did not have significant effect on overall survival as well (p = 0.582, 0.453, and 0.532, respectively). In the propensity score-matched patients, bursectomy still showed no significant effect on overall survival (p = 0.804).
  
  
  CONCLUSIONS
  Bursectomy is unlikely to improve overall survival in patients with macroscopically subserosa or serosa-positive gastric cancer.
authors.affiliation: Gastric Cancer Branch, Research Branch, Research Institute & Hospital, National Cancer Center, Goyang-si, Republic of Korea.
authors.forename: B W
authors.initials: BW
authors.lastname: Eom
authors.forename: J
authors.initials: J
authors.lastname: Joo
authors.forename: Y W
authors.initials: YW
authors.lastname: Kim
authors.forename: J M
authors.initials: JM
authors.lastname: Bae
authors.forename: K B
authors.initials: KB
authors.lastname: Park
authors.forename: J H
authors.initials: JH
authors.lastname: Lee
authors.forename: K W
authors.initials: KW
authors.lastname: Ryu
authors.forename: M C
authors.initials: MC
authors.lastname: Kook
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D005743:Gastrectomy; D061847:Hospitals, High-Volume; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D061646:Operative Time; D010529:Peritoneal Cavity / Q000601:surgery*; D012189:Retrospective Studies; D012704:Serous Membrane / Q000473:pathology*; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery*; D015996:Survival Rate
keywords: Bursectomy; Gastric cancer; JGCA; Japanese Gastric Cancer Association; Survival; TNM; UICC; Union Internationale contre le Cancer; tumor–node–metastasis