![]() ![]() The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomized Studies in Meta-Analyses. Wells G, Wells G, Shea B, Shea B, O’Connell D, Peterson J, et al. Timing of surgery after neoadjuvant chemoradiotherapy affects oncologic outcomes in patients with esophageal cancer. ![]() Shang Q-X, Yang Y-S, Gu Y-M, Zeng X-X, Zhang H-L, Hu W-P, et al. Does timing of esophagectomy following neoadjuvant chemoradiation affect outcomes? A meta-analysis. Qin Q, Xu H, Liu J, Zhang C, Xu L, Di X, et al. Dis Esophagus Off J Int Soc Dis Esophagus. Increasing the interval between neoadjuvant chemoradiotherapy and surgery in esophageal cancer: a meta-analysis of published studies. Verification of the optimal interval before esophagectomy after preoperative neoadjuvant chemoradiotherapy for locally advanced thoracic esophageal cancer. Wakita A, Motoyama S, Sato Y, Nagaki Y, Fujita H, Terata K, et al. Interval between neoadjuvant chemoradiotherapy and surgery for squamous cell carcinoma of the thoracic esophagus: does delayed surgery have an impact on outcome? Ann Surg. Ruol A, Rizzetto C, Castoro C, Cagol M, Alfieri R, Zanchettin G, et al. Surgical morbidity and mortality from the multicenter randomized controlled NeoRes II trial: standard versus prolonged time to surgery after neoadjuvant chemoradiotherapy for esophageal cancer. Nilsson K, Klevebro F, Rouvelas I, Lindblad M, Szabo E, Halldestam I, et al. Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): long-term results of a randomized controlled trial. Shapiro J, van Lanschot JJB, Hulshof MCCM, van Hagen P, van Berge Henegouwen MI, Wijnhoven BPL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Further, well-designed RCTs are required. National registry-based studies’ analysis shows that delay in surgery is riskier and leads to higher mortality and major complication rates. Available RCT reported surgical outcomes only. Delayed surgery was associated with increased mortality (OR 1.35, CI 1.07–1.69) and major complication rate (OR 1.55, CI 1.20–2.01). ![]() Analysis of registry studies showed that the delayed group had a better pCR rate (OR 1.12, CI 1.01–1.24), with no improvement in survival (HR 1.01, CI 0.92–1.10). Delayed surgery led to increased leak (OR 1.48, CI 1.11–1.97). Twelve retrospective studies, one RCT, and six registry-based studies (13,600 participants) were included. According to heterogeneity, fixed-effect or random-effect models were used. Survival data were pooled as Hazard Ratio (HR) and the rest as Odds Ratio (OR). Cohort studies and national registry bases studies were analysed separately. ![]() Overall Survival (OS) was the primary outcome, whereas pathological complete resolution (pCR), R0 resection, anastomotic leak, perioperative mortality, pulmonary complications, and major complication (> Clavien-Dindo grade 2) rates were secondary outcomes. 6–8 weeks were used as a cut-off to define early and delayed surgery groups. MethodsĪ systematic search of PubMed, Embase and Cochrane databases was conducted. However, the optimal timing of surgery after neoadjuvant therapy is not defined clearly. Neoadjuvant chemoradiotherapy (nCRT) followed by surgery, is the mainstay of managing locally advanced esophageal cancer. ![]()
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