Planned oesophagectomy after chemoradiotherapy versus salvage oesophagectomy following definitive chemoradiotherapy: a systematic review and meta‐analysis

Abstract

Background Oesophageal cancer is the eighth most common cancer and sixth leading cause of cancer‐related mortality worldwide. Salvage oesophagectomies are associated with an increased risk of mortality, although recent data suggests that long‐term survival rates following salvage oesophagectomy are similar to planned oesophagectomy. The aim was therefore to meta‐analyse outcomes for patients undergoing salvage versus planned oesophagectomies to assess the differences in short‐term mortality and long‐term survival. Methods A systematic review of Medline, Scopus, Web of Science and PubMed was performed to identify relevant studies. Data were extracted and compared by meta‐analysis, using odds ratio and mean differences with 95% confidence intervals. Results Nineteen studies meeting inclusion criteria were included in the meta‐analysis, which compared patients in the planned oesophagectomy group (n = 23 555) to patients in the salvage oesophagectomy group (n = 2227). There were significant differences between the groups in terms of rates of postoperative mortality (5.7% salvage oesophagectomy versus 3.1% planned oesophagectomy, P = 0.0004), anastomotic leak (20.6% salvage oesophagectomy versus 14.5% planned oesophagectomy, P < 0.00001), pulmonary complications (37.1% salvage oesophagectomy versus 24.2% planned oesophagectomy, P < 0.0001) and R0 margin (87.6% salvage oesophagectomy versus 91.3% planned oesophagectomy, P < 0.0001). There was no statistical difference between long‐term survival rates at 5 years with 39.2% for salvage and 42.6% for planned oesophagectomy (P = 0.28). Conclusions Salvage oesophagectomies do offer a meaningful chance of long‐term survival (at 5 years) for select patients with oesophageal cancer, but the elevated risk of post‐operative complications and mortality following salvage oesophagectomy should be recognized.