Types of Omentectomy in Surgical Practice
Yes, there are multiple types of omentectomy besides supracolic omentectomy, with infracolic omentectomy being the most commonly performed alternative type in gynecologic oncology procedures.
Main Types of Omentectomy
1. Infracolic Omentectomy
- Most commonly performed in gynecologic oncology, particularly for ovarian cancer staging
- Involves removal of the omental portion below the transverse colon
- Recommended as standard procedure in surgical staging for early ovarian cancer 1
- Performed by dissecting the omentum off the transverse colon in the avascular plane 2
2. Supracolic (Infragastric/Gastrocolic) Omentectomy
- Involves removal of the upper portion of the omentum near the greater curvature of the stomach
- Includes opening the lesser sac off the greater curvature of the stomach 2
- More extensive than infracolic omentectomy
- Recent evidence suggests improved detection of metastases compared to infracolic approach 3
3. Complete/Total Omentectomy
- Combines both infracolic and supracolic (infragastric) components
- Removes the entire greater omentum
- Typically performed in advanced ovarian cancer cases
- May be referred to as "omentectomy with peritonectomy" in extensive cytoreductive procedures 2
4. Partial Omentectomy
- Selective removal of portions of the omentum
- May be appropriate in certain gastric cancer cases (T3 or shallower tumors) 4
- Less commonly performed in gynecologic oncology
Clinical Applications by Cancer Type
Ovarian Cancer
- Infracolic omentectomy is standard for early-stage disease staging 1
- For FIGO stage I/II disease, infracolic omentectomy is part of comprehensive surgical staging 1
- For advanced disease (FIGO IIb-IIIc), complete omentectomy is typically performed 1
- Recent evidence suggests infragastric (supracolic) omentectomy may improve progression-free survival in stage IIB-IIIC patients with normal-appearing omentum 3
Gastric Cancer
- Traditionally involves total omentectomy with gastrectomy
- Recent evidence suggests partial omentectomy might be sufficient for T3 or shallower gastric tumors 4
Non-Epithelial Ovarian Cancers
- Infracolic omentectomy is part of standard staging procedures 1
Technical Considerations
- Robotic approaches for both infracolic and gastrocolic (supracolic) omentectomy are now feasible 5
- The choice between infracolic and infragastric approaches should consider:
- Disease stage and extent
- Appearance of the omentum (normal vs. abnormal)
- Surgical expertise and approach (open vs. minimally invasive)
Clinical Implications
- Infragastric (supracolic) omentectomy may improve detection of omental metastases (OR: 6.519) compared to infracolic approach 3
- In stage IIB-IIIC epithelial ovarian cancer with normal-appearing omentum, infragastric omentectomy improved progression-free survival (HR: 0.456) 3
- The goal of any omentectomy approach in ovarian cancer is to achieve optimal cytoreduction, as each 10% increase in maximal cytoreduction is associated with a 5.5% increase in median survival 2
Conclusion
The choice of omentectomy type should be based on disease characteristics, with infracolic omentectomy being standard for early-stage disease and more extensive approaches (infragastric/total) considered for advanced disease or when the omentum appears abnormal.