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Neoadjuvant Therapy Vs Upfront Surgery for Clinical T2N0 Esophageal Cancer: A Systematic Review
Journal article   Open access   Peer reviewed

Neoadjuvant Therapy Vs Upfront Surgery for Clinical T2N0 Esophageal Cancer: A Systematic Review

Biniam Kidane, Robert J Korst, Benny Weksler, Ashley Farrell, Gail E Darling, Linda W Martin, Rishindra Reddy and Inderpal S Sarkaria
The Annals of thoracic surgery, v 108(3), pp 935-944
Sep 2019
DOI: https://doi.org/10.1016/j.athoracsur.2019.04.008
PMID: 31077657
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.1016/j.athoracsur.2019.04.008View
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Abstract

Aged Disease-Free Survival Esophageal Neoplasms - drug therapy Esophageal Neoplasms - pathology Esophageal Neoplasms - surgery Esophagectomy - methods Female Humans Male Middle Aged Neoadjuvant Therapy Neoplasm Invasiveness - pathology Neoplasm Staging Outcome Assessment, Health Care Prognosis Randomized Controlled Trials as Topic Risk Assessment Survival Analysis United States
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. 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. 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. 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.

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26 citations in Web of Science
22 citations in Scopus

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Collaboration types
Domestic collaboration
International collaboration
Web of Science research areas
Cardiac & Cardiovascular Systems
Respiratory System
Surgery
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