PD01.07. Surgery Timing After Neoadjuvant Therapy for Esophageal Carcinoma: A Meta-Analysis of 7,544 Patients

Abstract

Esophageal Cancer: Adjuvant and Neo-Adjuvant Therapies In treating locally advanced esophageal carcinoma, neoadjuvant therapy followed by surgery represents a key approach. However, the timing of surgery following neoadjuvant therapy in esophageal carcinoma remains controversial. We conducted a systematic search of PubMed, EMBASE, Web of Science, and Cochrane Library for studies published up to August 1, 2024. Studies that compared delayed versus early surgery for locally advanced esophageal carcinoma following neoadjuvant therapy were included. A fixed-effects or random-effects model was used based on heterogeneity. A total of 21 studies involving 7,544 patients with esophageal carcinoma were analyzed. Delayed surgery was associated with a higher incidence of anastomotic leakage (OR = 1.39, P=0.007) and lower R0 resection rates (OR = 0.59, P < 0.001). However, there was no significant difference in pulmonary complications, perioperative mortality, or pathological complete response rates between the early and delayed surgery groups. Long-term overall survival was poorer in the delayed surgery group (HR = 1.12, P=0.05), although disease-free survival showed no significant difference. Additionally, There were no significant differences in the incidence of chylothorax, RLN injury, or postoperative cardiovascular complications between the groups. While delayed surgery after neoadjuvant therapy in esophageal carcinoma patients may be associated with a higher risk of anastomotic leaks and a lower rate of R0 resection, its impact on long-term survival remains an area of ongoing investigation. Future randomized controlled trials are needed to further clarify the optimal timing of surgery and identify potential benefits of delaying surgery in certain patients.