Do pathologists thoroughly Evaluate the Greater Omentum Following Gastrectomy for Malignancy: an Audit Based on Histopathology Reports

Introduction: Milky spots in greater omentum are primary sites for seeding of exfoliated cells from intra-abdominal malignancies. Surgery is the mainstay of treatment of gastric adenocarcinoma and the greater omentum is usually resected en-bloc.

Aim: To study the histopathological profile of gastric malignancies and to determine if pathologists routinely analyze the greater omentum submitted following gastrectomy.

Methods: An audit of histopathology records of patients who had gastric malignancies between 2008 and 2012 was undertaken. Data retrieved included patients’ demography, tumour site, tumour histology and subtypes, Helicobacter pylori status, associated gastritis, types of gastrectomy and; analysis and finding of omental deposits.

Results: 325 records were found of which 76.6% were adenocarcinomas. The overall male to female ratio of patients was 192:133 and their average age overall was 59.0 years (range: 23102 years). The average age of patients who had adenocarcinoma was 60.2 years. Around 8.8% of patients who had adenocarcinoma were younger than 40 years.

Gastric resection was performed in 23.1% adenocarcinomas of which 9.1% was stage I based on final histology. The greater omentum was part of specimen in 46.6% cases but report regarding cancer deposits was specified in 25.9% of which 11.1% were positive.

Conclusion: Pathologists do not routinely analyze and report findings on the greater omentum of patients who had gastrectomy for cancer. It potentially leads to under-staging. Analysis of the greater omentum for cancer cell deposits should be incorporated into the standard pathology reporting template for gastric cancer following curative gastrectomy.