Biniam Kidane1, Robert J Korst2, Benny Weksler3, Ashley Farrell4, Gail E Darling5, Linda W Martin6, Rishindra Reddy7, Inderpal S Sarkaria8. 1. Section of Thoracic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada; Division of Thoracic Surgery, University of Toronto, Toronto, Ontario, Canada. Electronic address: b.kidane@mail.utoronto.ca. 2. Department of Thoracic Surgery, Mount Sinai Health System, New York, New York; Valley/Mount Sinai Comprehensive Cancer Care, Paramus, New Jersey. 3. University of Tennessee Health Science Center, Memphis, Tennessee. 4. Library & Information Services, Toronto General Hospital, Toronto, Ontario, Canada. 5. Division of Thoracic Surgery, University of Toronto, Toronto, Ontario, Canada; Library & Information Services, Toronto General Hospital, Toronto, Ontario, Canada. 6. Division of Thoracic Surgery, University of Virginia, Charlottesville, Virginia. 7. Division of Thoracic Surgery, University of Michigan, Ann Arbor, Michigan. 8. Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Abstract
BACKGROUND: The optimal approach to clinical T2N0 (cT2N0) esophageal cancer is unclear. Our objective is to perform a systematic review investigating whether neoadjuvant therapy results in better outcomes compared with upfront surgery in cT2N0 esophageal cancer. METHODS: We performed a systematic review and meta-analysis of randomized and nonrandomized studies (1995 to 2017) comparing use of neoadjuvant therapy with upfront surgery in the treatment of cT2N0 esophageal cancer. Independent and duplicate assessment was used. All meta-analytical techniques were performed in RevMan 5.3. RESULTS: Nine cohort studies, including 5433 patients, were included for meta-analysis. Use of neoadjuvant therapy was associated with significantly higher complete resection rates compared with upfront surgery (risk ratio, 0.67; 95% confidence interval, 0.55 to 0.81; P < .001). There was no difference in 5-year overall or recurrence-free survival. There were no significant differences in perioperative mortality as well as perioperative complications, although meta-analysis results are limited by inconsistent reporting of such complications. Lymphovascular invasion and larger tumor size were significant predictors of upstaging. Four of the studies were at high risk of bias. The remaining 5 studies were larger and more robust but were assessed as being of uncertain risk of bias. CONCLUSIONS: Use of neoadjuvant therapy was associated with significantly higher complete resection rates compared with upfront surgery although this did not translate to differences in survival outcomes. No differences in perioperative morbidity or mortality were identified. Based on qualitative systematic review, lymphovascular invasion and larger tumor size are potential factors for helping to select those patients who may benefit from neoadjuvant therapy.
BACKGROUND: The optimal approach to clinical T2N0 (cT2N0) esophageal cancer is unclear. Our objective is to perform a systematic review investigating whether neoadjuvant therapy results in better outcomes compared with upfront surgery in cT2N0 esophageal cancer. METHODS: We performed a systematic review and meta-analysis of randomized and nonrandomized studies (1995 to 2017) comparing use of neoadjuvant therapy with upfront surgery in the treatment of cT2N0 esophageal cancer. Independent and duplicate assessment was used. All meta-analytical techniques were performed in RevMan 5.3. RESULTS: Nine cohort studies, including 5433 patients, were included for meta-analysis. Use of neoadjuvant therapy was associated with significantly higher complete resection rates compared with upfront surgery (risk ratio, 0.67; 95% confidence interval, 0.55 to 0.81; P < .001). There was no difference in 5-year overall or recurrence-free survival. There were no significant differences in perioperative mortality as well as perioperative complications, although meta-analysis results are limited by inconsistent reporting of such complications. Lymphovascular invasion and larger tumor size were significant predictors of upstaging. Four of the studies were at high risk of bias. The remaining 5 studies were larger and more robust but were assessed as being of uncertain risk of bias. CONCLUSIONS: Use of neoadjuvant therapy was associated with significantly higher complete resection rates compared with upfront surgery although this did not translate to differences in survival outcomes. No differences in perioperative morbidity or mortality were identified. Based on qualitative systematic review, lymphovascular invasion and larger tumor size are potential factors for helping to select those patients who may benefit from neoadjuvant therapy.
Authors: Rolfy A Perez Holguin; Elizabeth J Olecki; Kelly A Stahl; William G Wong; Charles C Vining; Matthew E B Dixon; June S Peng Journal: J Gastrointest Surg Date: 2022-08-30 Impact factor: 3.267