Influence of bursectomy on operative morbidity and mortality after radical gastrectomy for gastric cancer: Results of a randomized controlled trial

Background: Bursectomy, a procedure dissecting the peritoneal lining covering the pancreas and the anterior plane of the transverse mesocolon, has been commonly performed with radical gastrectomy for gastric cancer patients. Although possibly improving the prognosis of gastric cancers, adverse events related to bursectomy should be evaluated in prospective studies. Methods: This prospective randomized controlled trial was conducted by experienced surgeons in 11 Japanese institutions. Patients with T2 or T3 gastric adenocarcinoma were intraoperatively randomized to radical gastrectomy plus D2 lymphadenectomy either with or without bursectomy. Postoperative morbidity and mortality were compared between the two groups. Results: A total of 210 patients were assigned to the bursectomy group (104 patients) and the nonbursectomy group (106 patients) between July 2002 and January 2007. Background characteristics were well balanced. Intraoperative blood loss was greater in the bursectomy group than in the nonbursectomy group (median 475 vs. 350 ml, p = 0.047), whereas other surgical factors did not vary significantly. The overall morbidity rate was 14.3% (30 patients), the same for the two groups. Likewise, the incidence of major postoperative complications, including pancreatic fistula, anastomotic leakage, abdominal abscess, bowel obstruction, hemorrhage, and pneumonia, were not significantly different between the two groups. The medians of the amylase level of the drainage fluid on postoperative day 1 were similar for the two groups (median 282 vs. 314 IU/L, p = 0.543). The hospital mortality rate was 0.95%: one patient per group. Conclusions: Experienced surgeons could safely perform a D2 gastrectomy with an additional bursectomy without increased major surgical complications.