Bursectomy Not Recommended as Standard Treatment for cT3/T4 Gastric Cancer

Bursectomy can be safely performed without increasing the risk of morbidity or mortality among patients with cT3 or cT4 gastric cancer, though it is not recommended as a standard treatment in this setting, according to a study being presented at the 2017 Gastrointestinal Cancers Symposium.¹

Bursectomy for gastric cancer involves resection of the peritoneal lining covering the pancreas and the anterior plane of the transverse mesocolon. Although used to prevent peritoneal metastasis, its role in the treatment of gastric cancer is controversial.

To evaluate the efficacy and safety of bursectomy among patients with subserosal or serosal gastric cancer, researchers randomly assigned 1204 patients with histologically confirmed cT3 (subserosal) or cT4a (serosal) adenocarcinoma of the stomach from 57 institutions 1:1 to undergo bursectomy or not in an open-label, phase 3 trial (UNIM-CTR Clinical Trial Identifier: UMIN000003688).

At an interim analysis, 3-year overall survival was 86.0% (95% CI, 82.7-88.7) among those who did not undergo bursectomy compared with 83.3% (95% CI, 79.6-86.3) in the bursectomy arm (hazard ratio, 1.075; 98.5% CI, 0.760-1.520), leading to early termination of the study.

There was no significant difference in the incidence of grade 3 or higher adverse events between bursectomy and non-bursectomy arms, but there was a slightly higher incidence of pancreatic fistula in the bursectomy group.

Although the findings demonstrate that patients with cT3 or cT4a gastric cancer can safely undergo bursectomy without experiencing an increased risk of morbidity or mortality, the authors concluded that bursectomy should not be recommended as standard treatment for this population.

Reference

1. Terashima M, Doki Y, Kurokawa Y, et al. Primary results of a phase III trial to evaluate bursectomy for patients with subserosal/serosal gastric cancer (JCOG1001). J Clin Oncol. 2017;35(suppl):4S. Abstract 5.