Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for esophageal neoplasms: A systematic review and meta-analysis / 中国胸心血管外科临床杂志

ABSTRACT

@#Objective    To evaluate the efficacy and safety of neoadjuvant chemotherapy (a CRTS group) plus surgery versus surgery alone (a SA group) in the treatment of resectable esophageal neoplasms. Methods    PubMed, Ovid Technologies, SCI, CBM Database, CNKI Database, VIP Database and Wanfang Database were searched to identify all published or unpublished RCTs those compared neoadjuvant chemotherapy plus surgery with surgery alone for resectable esophageal neoplasms up to August 1, 2015. Meta-analysis was conducted by using Stata12.0 software. Results    Twenty-six RCTs included 3 252 patients (1 606 in the CRTS group, 1 646 in the SA group) were selected. There was a significant difference between the CRTS group and the SA group in 3-year survival rate, 5-year survival rate, R0 resection rate, local recurrence rate, local recurrence and distant metastasis rate with relative risk (RR) value and 95%CI at 1.24 (1.13–1.36, P<0.000 1), 1.29 (1.10–1.50, P=0.001), 1.13 (1.05–1.212, P=0.001), 0.67 (0.52–0.85, P=0.001), 0.60 (0.40–0.90, P=0.013). And there was no significant difference between the CRTS group and the SA group in 1-year survival rate and distant metastasis with RR (95%CI) of 1.05 (0.99–1.12, P=0.103) and 0.84 (0.70–1.00, P=0.053). There was no significant  difference in postoperative complications, 30-days mortality, pulmonary infections, anastomotic leakage, anastomotic stricture, cardiac complications, chylothorax between the two groups with RR (95%CI) at 1.09 (0.96–1.24, P=0.166), 1.32 (0.96–1.83, P=0.485), 1.45 (0.94–2.23, P=0.091), 0.89 (0.63–1.25, P=0.485), 0.93 (0.64–1.35, P=0.731), 1.24(0.84–1.87, P=0.283), and 1.62 (0.85–3.07, P=0.142). Conclusion    CRTS significantly benefits to survival rate, R0 rescetion rate, and local recurrence rate compared to SA. Additionally there is no increased postoperative complication for patients with resectable esophageal neoplasms.