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Meta-analysis of postoperative morbidity and perioperative mortality in patients receiving neoadjuvant chemotherapy or chemoradiotherapy for resectable oesophageal and gastro-oesophageal junctional cancers.
- Source :
-
The British journal of surgery [Br J Surg] 2014 Mar; Vol. 101 (4), pp. 321-38. Date of Electronic Publication: 2014 Feb 03. - Publication Year :
- 2014
-
Abstract
- Background: The long-term survival benefits of neoadjuvant chemotherapy (NAC) and chemoradiotherapy (NACR) for oesophageal carcinoma are well established. Both are burdened, however, by toxicity that could contribute to perioperative morbidity and mortality.<br />Methods: MEDLINE, the Cochrane Library and Embase were searched to capture the incidence of any postoperative complications, cardiac complications, respiratory complications, anastomotic leakage, postoperative 30-day mortality, total postoperative mortality and treatment-related mortality in randomized clinical trials comparing NAC or NACR with surgery alone, or NAC versus NACR. Meta-analyses comparing NAC and NACR were conducted by using adjusted indirect comparison.<br />Results: Twenty-three relevant studies were identified. Comparing NAC or NACR with surgery alone, there was no increase in morbidity or mortality attributable to neoadjuvant therapy. Subgroup analysis of NACR for squamous cell carcinoma (SCC) suggested an increased risk of total postoperative mortality and treatment-related mortality compared with surgery alone: risk ratio 1·95 (95 per cent confidence interval 1·06 to 3·60; Pā=ā0·032) and 1·97 (1·07 to 3·64; Pā=ā0·030) respectively. A combination of direct comparison and adjusted indirect comparison showed no difference between NACR and NAC regarding morbidity or mortality.<br />Conclusion: Neither NAC nor NACR for oesophageal carcinoma increases the risk of postoperative morbidity or perioperative mortality compared with surgery alone. There was no clear difference between NAC and NACR. Care should be taken with NACR in oesophageal SCC, where an increased risk of postoperative mortality and treatment-related mortality was apparent.<br /> (© 2014 BJS Society Ltd. Published by John Wiley & Sons Ltd.)
- Subjects :
- Adenocarcinoma mortality
Anastomotic Leak etiology
Anastomotic Leak mortality
Antineoplastic Combined Chemotherapy Protocols adverse effects
Carcinoma, Squamous Cell mortality
Chemotherapy, Adjuvant adverse effects
Esophageal Neoplasms mortality
Esophageal Squamous Cell Carcinoma
Heart Diseases etiology
Heart Diseases mortality
Humans
Postoperative Complications mortality
Randomized Controlled Trials as Topic
Respiratory Tract Diseases etiology
Respiratory Tract Diseases mortality
Risk Factors
Selection Bias
Adenocarcinoma therapy
Carcinoma, Squamous Cell therapy
Chemoradiotherapy adverse effects
Esophageal Neoplasms therapy
Esophagogastric Junction surgery
Postoperative Complications etiology
Subjects
Details
- Language :
- English
- ISSN :
- 1365-2168
- Volume :
- 101
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- The British journal of surgery
- Publication Type :
- Academic Journal
- Accession number :
- 24493117
- Full Text :
- https://doi.org/10.1002/bjs.9418