During the treatment of certain cancers, the removal of a membrane that lines the abdomen is one of the hypotheses. Omentectomy in cancer can prevent disorders but also prolong survival. In which cases is it indicated? What are the benefits? Let’s take stock of this procedure.

Surgery can be part of the treatment for cancer. The type and extent of surgery are discussed with a multidisciplinary team: surgeons, oncologists and radiologists. Together, they work closely together to determine the best time for surgery, depending on the disease and other treatments. 

Omentectomy is a procedure in which all or part of the abdominal wall is removed. The tissue that needs to be removed is called the omentum. This fatty organ is made up of the peritoneum located under the stomach covering part of the colon. This procedure is used to check for the presence of cancer cells. This area is also called “large omentum”, hence the name omentectomy given to this intervention.

The greater omentum is a fatty tissue that covers the organs located in the abdomen, the peritoneum. 

We distinguish:

• The lesser omentum, from the stomach to the liver;
• The greater omentum, located between the stomach and the transverse colon.

Omentectomy is said to be partial when only one part of the omentum is removed, total when the surgeon removes it entirely. The ablation has no specific consequences.

This can be done during cancer surgery.

This operation is indicated in patients with gynecological cancer of the ovary or uterus and digestive cancer involving the stomach. 

Surrounded by the peritoneum, the omentum protects the organs of the abdomen. It is made up of fatty tissue, blood vessels, and immune cells. 

Removal of the omentum may be necessary:

• In case of attack by already cancerous cells in the ovaries, uterus or intestine;
• As a precaution: in people with cancer in an organ located near the omentum, omentectomy is performed to prevent it from spreading there;
• In rare cases, in case of inflammation of the peritoneum (peritonitis);
• In type 2 diabetes: by reducing the amount of fatty tissue near the abdomen, it is possible to regain better insulin sensitivity.

Omentectomy can be done in two ways:

• or a laparoscopy: 4 small scars on the stomach allow a camera and instruments to pass through. It requires hospitalization of 2-3 days only;
•  or a laparotomy: a large median vertical scar between the thorax and the pubis allows the abdomen to open. Hospitalization is approximately 7-10 days, depending on the actions performed during the procedure.

The blood vessels circulating in the omentum are clamped (in order to stop or prevent the bleeding). Then, the omentum is carefully separated from the peritoneum before being removed.

Omentectomy is usually performed under general anesthesia at the same time as other surgeries. In case of gynecological cancer, removal of the ovaries, uterine tubes, or uterus is to be expected. In this case, it is then an important hospitalization requiring to stay a certain number of days at home.

In cancerous disease, the prognosis after omentum removal depends on the stage of the disease. Usually, the cancer is already at an advanced stage. The surgical intervention allows:

• To reduce complications such as the accumulation of fluid in the abdomen (ascites);
• To extend survival for several months. 

In the long term, the effects of removing the omentum are still uncertain, as the involvement of this tissue remains poorly understood.

After the intervention, the person is observed and taken care of in the intensive care unit. Generally, people can be transferred the next day to the day unit. 

Treatment and follow-up care depends on the type and stage of the cancerous condition. When the procedure is performed on a person with cancer, it can be followed by chemotherapy sessions to optimize the chances of recovery. 

The risks associated with this intervention are related:

• With anesthesia: risk of allergic reaction to the product used;
• Has wound infection; 
• In very rare cases, cause a paralytic ileus, that is to say, an arrest of intestinal transit;
• Exceptionally, the operation can damage a surrounding structure: perforation of the duodenum for example, the first portion of the small intestine.