Evidence map›Paper›PMID 36800076›Full record

SynthesisEsophagus : official journal of the Japan Esophageal Society2023

Early versus delayed surgery following neoadjuvant chemoradiation for esophageal cancer: a systematic review and meta-analysis.

Mithun Nariampalli Karthyarth, Anvin Mathew, Deepti Ramachandra, Anuj Goyal, Neeraj Kumar Yadav, Kamireddy Madana Raghava Reddy, Nirjhar Raj Rakesh, Gourav Kaushal, Puneet Dhar

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In one paragraph

Synthesis in Esophagus : official journal of the Japan Esophageal Society, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

9 authors.

Mithun Nariampalli KarthyarthDepartment of Surgical Gastroenterology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India.
Anvin MathewDepartment of Surgical Gastroenterology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India. mathewanvin@gmail.com.ORCID 0000-0001-9130-1578
Deepti RamachandraDepartment of Surgical Gastroenterology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India.
Anuj GoyalDepartment of Surgical Gastroenterology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India.
Neeraj Kumar YadavDepartment of Surgical Gastroenterology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India.
Kamireddy Madana Raghava ReddyDepartment of General Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India.
Nirjhar Raj RakeshDepartment of Surgical Gastroenterology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India.
Gourav KaushalDepartment of Surgical Gastroenterology, All India Institute of Medical Sciences, Bathinda, Punjab, 151001, India.
Puneet DharDepartment of Surgical Gastroenterology, Amrita Institute of Medical Sciences, Faridabad, Haryana, 121002, India.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundNeoadjuvant chemoradiotherapy (nCRT) followed by surgery, is the mainstay of managing locally advanced esophageal cancer. However, the optimal timing of surgery after neoadjuvant therapy is not defined clearly.

methodsA systematic search of PubMed, Embase and Cochrane databases was conducted. 6-8 weeks were used as a cut-off to define early and delayed surgery groups. 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. Cohort studies and national registry bases studies were analysed separately. Survival data were pooled as Hazard Ratio (HR) and the rest as Odds Ratio (OR). According to heterogeneity, fixed-effect or random-effect models were used.

resultsTwelve retrospective studies, one RCT, and six registry-based studies (13,600 participants) were included. Pooled analysis of cohort studies showed no difference in OS (HR 1.03, CI 0.91-1.16), pCR (OR 0.98, CI 0.80-1.20), R0 resection (OR 0.90, CI 0.55-I.45), mortality (OR 1.03, CI 0.59-1.77), pulmonary complications (OR 1.26, CI 0.97-1.64) or major complication rates (OR 1.29, CI 0.96-1.73). Delayed surgery led to increased leak (OR 1.48, CI 1.11-1.97). 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 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). Available RCT reported surgical outcomes only.

conclusionNational registry-based studies' analysis shows that delay in surgery is riskier and leads to higher mortality and major complication rates. Further, well-designed RCTs are required.

Indexed as

Esophageal NeoplasmsNeoadjuvant TherapyEsophagectomyHumansRetrospective StudiesTreatment OutcomeDelayed surgeryEsophageal cancerNeoadjuvant chemoradiation

Identifiers

PMID36800076

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.