Impact of Neoadjuvant Chemoradiation on Short-Term Outcomes for Esophageal Squamous Cell Carcinoma Patients: A Meta-analysis.
Neoadjuvant chemoradiation (NCRT) has emerged as a component of the standard treatment for esophageal squamous cell carcinoma (SCC). The primary benefit of NCRT is an improvement in long-term survival; however, the impact of NCRT on short-term outcomes is unclear.



A comprehensive electronic literature search was performed via the MEDLINE (PubMed), Cochrane Library, and Google Scholar databases through November 2015 for the inclusion of randomized controlled trials (RCTs) that evaluated short-term outcomes of patients administered NCRT followed by surgery compared with surgery alone for resectable esophageal SCC. The main outcome measures were postoperative mortality and morbidity. A meta-analysis was performed using random-effects models to calculate odds ratios (ORs) with 95 % confidence intervals (CIs).



Eight RCTs were included, for a total of 1058 patients. Meta-analysis of the overall postoperative mortality and cardiopulmonary complication rates showed that there was a significant increase for patients administered NCRT followed by surgery compared with surgery alone (OR 1.87, 95 % CI 1.07-3.28, p = 0.03, number of patients needed to harm = 33.3; and OR 2.12, 95 % CI 1.03-4.35, p = 0.04, respectively). Dropout before surgery was higher for patients in the NCRT followed by surgery group compared with patients in the surgery-alone group. NCRT has no statistically impact on anastomosis and other complications compared with surgery alone.



NCRT for esophageal SCC significantly increases postoperative mortality and cardiopulmonary complications.
Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan.|Department of Surgery, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand.
Suun
S
Sathornviriyapong
Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan. a-matsu@nms.ac.jp.
Akihisa
A
Matsuda
Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan.
Masao
M
Miyashita
Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan.
Satoshi
S
Matsumoto
Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan.
Nobuyuki
N
Sakurazawa
Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan.
Yoichi
Y
Kawano
Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan.
Marina
M
Yamada
Department of Surgery, Nippon Medical School, Tokyo, Japan.
Eiji
E
Uchida
D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant / Q000009:adverse effects; D004938:Esophageal Neoplasms / Q000401:mortality / Q000628:therapy*; D016629:Esophagectomy / Q000009:adverse effects*; D006331:Heart Diseases / Q000209:etiology*; D006801:Humans; D008171:Lung Diseases / Q000209:etiology*; D020360:Neoadjuvant Therapy / Q000009:adverse effects; D010352:Patient Dropouts; D011183:Postoperative Complications / Q000209:etiology*; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome