EARLY VERSUS DELAYED SURGERY FOLLOWING NEOADJUVANT CHEMORADIATION FOR ESOPHAGEAL CANCER: A SYSTEMATIC REVIEW AND META-ANALYSIS
Mithun Nariampalli Karthyarth*, Anvin Mathew, Deepti Ramachandra, Anuj Goyal, Nirjhar R. Rakesh, Puneet Dhar, Neeraj Yadav
ALL INDIA INSTITUTE OF MEDICAL SCIENCES, RISHIKESH, Rishikesh, Uttarakhand, India
Background
The aim of this study was to assess the association between interval between nCRT and
surgery and oncological and surgical outcomes in esophageal cancer patients.
Methods:
Pubmed, Embase and Cochrane data base were searched to identify eligible studies from
their inception to December 31, 2021 and divided into early and delayed surgery group. A
total of 19 studies with 12 retrospective cohort study, one randomized control trial and 6
data base registry study were included. A total of 13600 participants with 6395 participants
in early group and 7205 participants in delayed group were analyzed.
Results:
Pooled analysis of cohort studies comparing delayed surgery versus early surgery
showed no difference in OS (Hazard ratio (HR) 1.03 95% CI 0.91,1.16), pCR rate(Odds
Ratio (OR) 0.98, 95% CI 0.80, 1.20), R0 resection rate(OR 0.90, 95% CI 0.55, I.45;
I2=43%), perioperative mortality(OR1.03, 95% CI 0.59, 1.77; I2=0%), pulmonary (OR 1.26
95% CI 0.97,1.64; I2=22%) or major complication rate (OR 1.29, 95% CI 0.96, 1.73;
I2=29%) but was however associated with an increased anastomotic leak rate(OR 1.48,
95%CI 1.11,1.97). Mean while pooled assessment of data base registry studies showed
Delayed surgery resulted in increased pCR rate (OR 1.12, 95%CI 1.01, 1.24) which
however failed to translate to increased overall survival(HR 1.01, 95%CI 0.92 , 1.10; I2
=0%). But delayed surgery was associated with increased perioperative mortality(OR 1.35,
95% CI 1.07, 1.69; I2=15%), and major complication rate (OR 1.55; 95% CI 1.20, 2.01 I2=
26%)compared to early surgery.
Conclusion:
Delayed surgery produces equivalent oncological and surgical outcome except increased
anastomotic leak rates in high volume center. However, the result should be interpreted
with caution because of contradictory results between cohort studies and data base
registry studies.
Back to 2023 Abstracts