Published online Oct 27, 2021. doi: 10.4240/wjgs.v13.i10.1235
Peer-review started: March 22, 2021
First decision: August 15, 2021
Revised: August 23, 2021
Accepted: September 19, 2021
Article in press: September 19, 2021
Published online: October 27, 2021
A meta-analysis of eleven randomized controlled trials did not demonstrate a survival benefit when comparing neoadjuvant chemotherapy (NACT) plus surgery vs surgery alone. There is uncertainty as to whether it is only neoadjuvant therapy that provides an improvement to overall survival, or other factors such as pre-operative staging, patient selection, or extent of resection and lymphadenectomy.
Techniques in oesophagectomy are improving, but the regimen for neoadjuvant therapies has largely remained static.
The authors aimed to assess the effect of addition of NACT to a standardized surgery and lymphadenectomy on overall and disease-free survival in patients undergoing curative oesophagectomy for oesophageal adenocarcinoma.
Survival data in a prospectively maintained surgical database were interrogated to review demographic, surgical, and survival outcomes. These were compared between groups according to treatment and nodal count.
The authors found that overall and disease-free survival were similar between patients that had undergone NACT preceding surgery and surgery only groups. There was improved survival in patients with ≥ 30 nodes removed than those with < 30 nodes and a better disease-free survival that neared significance.
NACT did not appear to affect overall or disease-free survival in our cohort. Instead, an overall survival benefit was observed in patients who had ≥ 30 lymph nodes removed, and a benefit in disease-free survival which neared significance. Ideally, surgeons should aim to harvest more than 30 lymph nodes in the contemporary era.
Conflicting results and mixed data in multiple studies suggests the need for further randomised controlled trials of neoadjuvant therapy and surgery with lymphadenectomy compared with surgery with lymphadenectomy alone.