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Impact of Neoadjuvant Chemoradiation on Short-Term Outcomes for Esophageal Squamous Cell Carcinoma Patients: A Meta-analysis

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

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.

Methods

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).

Results

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.

Conclusions

NCRT for esophageal SCC significantly increases postoperative mortality and cardiopulmonary complications.

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    Authors and Affiliations

    1. Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan

      Suun Sathornviriyapong MD, Akihisa Matsuda MD, Masao Miyashita MD, Satoshi Matsumoto MD, Nobuyuki Sakurazawa MD, Yoichi Kawano MD & Marina Yamada PhD

    2. Department of Surgery, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand

      Suun Sathornviriyapong MD

    3. Department of Surgery, Nippon Medical School, Tokyo, Japan

      Eiji Uchida MD

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    Suun Sathornviriyapong and Akihisa Matsuda have contributed equally to this work.

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    Supplementary material 1 Flow chart of selection of studies for inclusion in meta-analysis (DOCX 15 kb)

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    Supplementary material 2 Funnel plot showing depicting the distribution of odds ratio for the studies in this meta-analysis on postoperative mortality (DOCX 76 kb)

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    Sathornviriyapong, S., Matsuda, A., Miyashita, M. et al. Impact of Neoadjuvant Chemoradiation on Short-Term Outcomes for Esophageal Squamous Cell Carcinoma Patients: A Meta-analysis. Ann Surg Oncol 23, 3632–3640 (2016). https://doi.org/10.1245/s10434-016-5298-9

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