# Clinical Characteristics of Patients Undergoing D2 Gastrectomy with Bursectomy in Gastric Cancer Patients: An Observational Study

## TL;DR

This study examines the clinical outcomes of D2 gastrectomy with bursectomy in gastric cancer patients, focusing on its relevance and safety in Nepal.

## Contribution

The study evaluates the practice of bursectomy in Nepal despite global guidelines discouraging it, providing local clinical data on its safety and outcomes.

## Key findings

- Tumor deposits in the bursa were found in 8.57% of patients.
- Bursectomy did not increase post-operative complications.
- Most patients had distal gastric lesions with advanced tumor stages.

## Abstract

Gastric cancer is a significant global and national health problem with high incidence and mortality rates. Despite advancements in treatment, local recurrence, mainly peritoneal, is common. Bursectomy, once the standard of surgery in resectable GC to reduce recurrence by removing the peritoneal membranes’ micro-metastasis, poses risks like pancreatic injury. Japanese guidelines now advise against it due to limited survival benefits, recommending D2 dissection with omentectomy instead. However, bursectomy is still routinely practiced in Nepal. This study evaluates its relevance, risks, and compliance with global guidelines.

This descriptive cross-sectional study was conducted at Bir Hospital from March 2024 to May 2025, involving 35 patients with resectable stage Ib—III gastric cancer who underwent D2 gastrectomy with bursectomy. Ethical approval was obtained from NAMS IRB. Patients with poor performance status or metastasis were excluded. All procedures were performed by experienced consultant surgical gastroenterologists, and specimens were sent separately for examination.

Among 39 selected patients, 35 underwent curative D2 gastrectomy with bursectomy. Among them, 20 (57.14%) were male, with a mean age of 60.54±13.81 years and performance status 0-2. 33 (94.28%) patients had distal gastric lesions; among them, 27 (77.13%) patients had cT3+cT4 lesions. Tumor deposits in the bursa were seen in 3(8.57%) patients. There were procedure-specific complications like 2(5.71%) biochemical leaks, delayed 4(11.43%) gastric emptying, and 3(8.57%) postoperative ileus. There was no mortality. 18 (51.42%) patients were followed up for more than 6 months.

There are tumor deposits in the bursa, and bursectomy doesn’t increase the post-operative complications.