Total omental bursa resection includes complete resection of the greater omentum, the anterior lobe of the transverse colonic mesentery, and the pancreatic peritoneum. The 14th edition of the Japanese Statute of Gastric Cancer describes omental bursa resection as having no high-level evidence of benefit in preventing peritoneal recurrence in cases where tumor has invaded the plasma membrane of the posterior gastric wall, although resection of the omental bursa may serve the purpose of removing microscopic implanted lesions within the bursa. The procedure is best avoided, at least in patients with gastric cancer without plasma membrane infiltration, because of the potential for vascular or pancreatic injury. However, small randomized controlled trials have reported that omental bursa removal may improve the prognosis in plasma-infiltrating gastric cancer.