Preoperative chemotherapy for resectable XXXX .

@entity1 @entity137 @entity5 @entity189 @entity418
BACKGROUND: Surgery has been the treatment of choice for @entity1 with localized @entity418 . Several studies have investigated whether preoperative chemotherapy followed by surgery leads to improvement in cure rates, but individual reports have provided conflicting results. An explicit systematic update of the role of preoperative chemotherapy in the treatment of @entity1 with resectable @entity418 is, therefore, warranted. OBJECTIVES: The objective of this review is to determine the role of preoperative chemotherapy in the treatment of @entity1 with resectable @entity418 . SEARCH METHODS: We identified trials by searching the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1966 to 2013), EMBASE (1988 to 2013), and CANCERLIT (1993 to 2013). We did not confine our search to English language publications. We updated searches in CENTRAL, MEDLINE, and EMBASE in October 2013. SELECTION CRITERIA: All trials of @entity1 with potentially resectable @entity189 (of any histologic type) who were randomly assigned to chemotherapy or no chemotherapy before surgery. DATA COLLECTION AND ANALYSIS: The primary outcome was survival, which was assessed with the use of hazard ratios. This is an amendment to the original review, which used risk ratios to assess survival at yearly intervals. Hazard ratios (HRs) have now been introduced to summarize the complete survival experience in a single analysis. Risk ratios (RRs) were used to compare rates of resection, @entity5 recurrences, and treatment morbidity and mortality. MAIN RESULTS: We identified a total of 13 randomized trials involving 2362 @entity1 . Ten trials (2122 @entity1 ) reported sufficient detail on survival to be included in a meta-analysis for the primary outcome. Preoperative chemotherapy improves overall survival (HR 0.88, 95% confidence interval (CI) 0.80 to 0.96) and is associated with a significantly higher rate of complete (R0) resection (RR 1.11, 95% CI 1.03 to 1.19).No evidence suggests that the overall rate of resection (RR 0.96, 95% CI 0.92 to 1.01), @entity5 recurrence (RR 0.81, 95% CI 0.54 to 1.22) or nonfatal complications (RR 0.90; 95% CI 0.76 to 1.06) was different for preoperative chemotherapy compared with surgery alone. Trials reported risks of @entity137 with chemotherapy that ranged from 11% to 90%. AUTHORS' CONCLUSIONS: In summary, preoperative chemotherapy plus surgery offers a survival advantage compared with surgery alone for @entity1 with resectable @entity418 , but the evidence is of moderate quality. Some evidence of @entity137 and preoperative mortality have been associated with chemotherapy.
