Bursectomy Does Not Improve Survival in Gastric Cancer

Bursectomy does not improve survival rates among patients with resectable gastric cancer compared with omentectomy alone (non-bursectomy), according to a study published in The Lancet Gastroenterology & Hepatology.¹

For the open-label phase 3 JCOG1001 study, researchers randomly assigned 1204 patients with gastric adenocarcinoma to undergo omentectomy only or bursectomy. Participants were between the ages of 20 and 80 years, had an ECOG performance status of 0 or 1, a body mass index less than 30 kg/m², and did not have bulky lymph nodes or distant metastases.

Results at the second interim analysis led to the Japan Clinical Oncology Group (JCOG) Data and Safety Monitoring Committee recommending early publication on the basis of futility. Patients in the bursectomy group had a worse overall survival (OS) compared with the non-bursectomy group, and the predictive probability of the final analysis showing a significantly higher OS in the bursectomy group was only 12.7%.

The 5-year OS rate was 76.7% vs 76.9% among patients who underwent non-bursectomy vs bursectomy (hazard ratio [HR], 1.05; 95% CI, 0.81-1.37; P = .65).

Grade 3 to 4 surgical morbidity was observed in 11% and 13% of patients in the non-bursectomy group and bursectomy group, respectively, and pancreatic fistula occurred at a significantly higher rate among patients who underwent bursectomy.

The authors concluded that “patients with resectable gastric cancer should not undergo bursectomy as a standard surgery. Our findings will accelerate the trend toward less-invasive surgery in the treatment of gastric cancer worldwide.”

Reference

1. Kurokawa Y, Doki Y, Mizusawa J, et al. Bursectomy versus omenectomy alone for resectable gastric cancer (JCOG1001): a phase 3, open-label, randomised controlled trial. Lancet Gastroenterol Hepatol. 2018 Apr 27. doi: 10.1016/S2468-1253(18)30090-6 [Epub ahead of print]