Clinical complete response after chemoradiotherapy for carcinoma of thoracic esophagus: Is esophagectomy always necessary? A systematic review and meta-analysis.
BACKGROUND
Although a clinical complete response (cCR) after chemoradiotherapy (CRT) could lead to a better prognosis, the choice of a following strategy, such as surgical or non-surgical approach, remains controversial.


METHODS
All articles relevant to a comparison of surgical and non-surgical treatment (including further definitive chemoradiotherapy or active surveillance) for esophageal carcinoma patients with a cCR after CRT were retrieved for meta-analysis. The final date for data retrieval was 30 June 2018.


RESULTS
Four retrospective studies including 648 patients met the inclusion criteria: 620 with squamous cell carcinoma and 28 with adenocarcinoma. The CRT + surgery group had an advantage over the non-surgery group in regard to two-year disease-free survival (DFS); however, the two groups showed similar results in five-year DFS. The CRT + surgery group had an advantage over the non-surgery group in two-year overall survival (OS); nevertheless, the two groups showed similar results in five-year OS.


CONCLUSIONS
Based on the available evidence, the addition of surgery to thoracic locally advanced esophageal carcinoma patients with a cCR after neoadjuvant CRT provided no advantage to long-term survival. As an exception, the two-year DFS and OS could be improved. This research conclusion might be more suitable to patients with squamous cell carcinoma.
['Wang|Jun|J|0000-0002-9733-1433', 'Qin|Jianjun|J|', 'Jing|Shaowu|S|', 'Liu|Qing|Q|', 'Cheng|Yunjie|Y|', 'Wang|Yi|Y|', 'Cao|Feng|F|']
D000230:Adenocarcinoma D002294:Carcinoma, Squamous Cell D059248:Chemoradiotherapy D003131:Combined Modality Therapy D004938:Esophageal Neoplasms D016629:Esophagectomy D005260:Female D006801:Humans D008297:Male D011379:Prognosis D017594:Publication Bias D016896:Treatment Outcome
clinical complete response Chemoradiotherapy esophageal carcinoma