Need an omentectomy? Here’s what to expect

If you need an omentectomy as a part of your cancer treatment, you probably have a lot of questions. 

To learn more about who needs this surgical procedure, why it’s done, and what to expect after you’ve had one, we checked in with gynecologic oncologist Nicole Fleming, M.D.

What’s an omentectomy?

An omentectomy is a surgical procedure in which the omentum — or layer of fat and blood vessels that projects off the colon and stomach— is removed.

The omentum has two parts: 

1. Supracolic: stretches from the stomach down to the transverse colon, or a horizontal section of the large intestine
2. Infracolic: projects down from the transverse colon like an apron around the waist 

The supracolic and infracolic omentum can be removed together or separately. The omentum is a big structure, though, so specimens removed for analysis can be quite large. If there is no obvious evidence of cancer involving the omentum, an omental biopsy may be performed to check for microscopic involvement as part of a staging procedure.

Which cancer patients might need an omentectomy?

Omentectomies are used to diagnose, stage, and treat the following metastatic cancers:

• ovarian cancer
• endometrial cancer
• colorectal cancer
• pancreatic cancer
• appendix cancer

Among gynecologic cancers, ovarian cancer most commonly spreads to the omentum, with endometrial cancer a distant second. 

Why is an omentectomy necessary?

Ovarian cancers readily spread to the omentum early in their metastasis. The reason is thought to be due to the shedding of cancer cells from the primary tumor.

An omentectomy may also be part of a surgical debulking procedure — that is, removal of as much of the tumor growth as possible for treatment of known metastatic cancer.

An omentectomy can be a part of a surgical staging procedure to see if early-stage cancer has spread, too. Even if abdominal imaging appears negative for metastatic tumor spread, we want to ensure there is no microscopic evidence of peritoneal or omental spread. In those cases, we might remove a portion of normal-appearing omentum and send that for pathologic analysis. These results could alter the stage of a newly diagnosed cancer and affect the treatment plan.

How long does it typically take to recover from an omentectomy?

That depends on the patient and what else they’re having done. Omentectomies are frequently done in conjunction with other surgeries, such as the removal of a tumor, or removal of the ovaries, uterus or fallopian tubes.  Omentectomies can be performed through an open (traditional) abdominal surgery or a minimally invasive (laparoscopic or robotic) surgery.

When an omentectomy is performed during open abdominal surgery, patients usually spend two to three days in the hospital, followed by another four weeks of recovery at home. When an omentectomy is performed using minimally invasive surgical techniques that don’t require large incisions, the procedure can be done as an outpatient, or with overnight hospitalization. With those, patients are discharged from the hospital either the same day or the next day.

Do omentectomies have any side effects? 

Not really. Since the omentum doesn’t affect significant organ function in our bodies, its removal doesn’t appear to affect anything negatively. 

The only thing I would caution patients about is being sure to let future doctors or surgeons know they’ve had an omentectomy if they are undergoing another abdominal surgery because the surgeon will need to be extra careful upon entering the abdominal cavity. 

When we perform abdominal surgery, usually, the first thing we encounter after making an incision in the omentum. That’s why it’s sometimes called “the guardian of the abdomen.” Once you’ve had an omentectomy, though, that “guardian” is no longer there. So, the first thing subsequent surgeons might encounter would be scar tissue or the intestines. This could lead to a slightly higher risk of bowel injury.

What’s the one thing patients should know about omentectomies?

There is no long-term health risk to removing this structure. So, it shouldn’t cause any disruption to your normal bodily functions. 

Request an appointment at MD Anderson online or by calling 1-877-632-6789.