Neoadjuvant Chemoradiotherapy Improving Survival Outcomes for Esophageal Carcinoma

Abstract

Background:The effectiveness of neoadjuvant chemoradiotherapy (NCRT) treatment for patients with esophageal carcinoma (EC) remains controversial. The aim of this study was to compare the effect of NCRT followed by surgery (NCRTS) with surgery alone (SA) for EC.Methods:The PubMed, EMBASE, and the Cochrane Library databases were electronically searched up to August 2015 for all the published studies that investigated EC patients receiving either NCRTS or SA, and the reference lists were also manually examined for the eligible studies. The risk ratio (RR) with 95% confidence intervals (CIs) as effective size was determined to assess the 1-, 3-, 5-year survival rates (SRs), postoperative morbidity, and postoperative mortality. Heterogeneity was determined using the Q-test. The Begg's test and Egger's test were used for assessing any potential publication bias.Results:Of 1120 identified studies, 16 eligible studies were included in this analysis (involving 2549 patients). Overall, the pooled results suggested that NCRTS was associated with significantly improved 1-year (RR: 1.07, 95% CI: 1.02–1.13), 3-year (RR: 1.26, 95% CI: 1.14–1.39), and 5-year (RR: 1.36, 95% CI: 1.18–1.56) SRs. However, the results also indicated that NCRTS had no or little effect on postoperative morbidity (RR: 0.93, 95% CI: 0.82–1.05) and postoperative mortality (RR: 1.17, 95% CI: 0.56–2.44).Conclusions:Compared with SA, NCRTS can increase 1-, 3-, and 5-year SRs in patients with EC.

Comparison of Outcomes with Semi‐mechanical and Circular Stapled Intrathoracic Esophagogastric Anastomosis following Esophagectomy

“…Both short-and long-term morbidity and mortality are driven by perioperative complications [3,4]. While many studies have focused on centralization of cancer care, enhanced recovery following surgery and neoadjuvant and adjuvant therapies [5][6][7][8][9][10][11], a key unanswered question is the ideal anastomotic technique.…”

Efficacy of chemo-radiotherapy versus radiotherapy alone in the treatment of esophageal carcinoma

“…In a meta-analysis by Zhu et al, nine studies which included 1,135 cases (612 received concurrent chemoradiotherapy and 523 received radiotherapy alone) showed that patients who received concurrent chemoradiotherapy, demonstrated significantly higher overall response rate and reduced the risk of persistence and recurrence of disease [14][15][16][17][18].…”

Author's Reply: Comparison of Outcomes with Semi‐mechanical and Circular Stapled Intrathoracic Esophagogastric Anastomosis following Esophagectomy

“…Semi‐mechanical technique was favored by local thoracic surgeons for cervical anastomosis. This gradually gained popularity to be used for intrathoracic anastomosis as well, based on published studies [4–7] and local expertise recommendation. This resulted in a significant reduction in leak rates as demonstrated in our study [1].…”