Abstract
BACKGROUND: Although a clinical complete response (cCR) after chemoradiotherapy (CRT) could lead to a better prognosis, the choice of a following strategy, such as surgical or non-surgical approach, remains controversial. METHODS: All articles relevant to a comparison of surgical and non-surgical treatment (including further definitive chemoradiotherapy or active surveillance) for esophageal carcinoma patients with a cCR after CRT were retrieved for meta-analysis. The final date for data retrieval was 30 June 2018. RESULTS: Four retrospective studies including 648 patients met the inclusion criteria: 620 with squamous cell carcinoma and 28 with adenocarcinoma. The CRT + surgery group had an advantage over the non-surgery group in regard to two-year disease-free survival (DFS); however, the two groups showed similar results in five-year DFS. The CRT + surgery group had an advantage over the non-surgery group in two-year overall survival (OS); nevertheless, the two groups showed similar results in five-year OS. CONCLUSIONS: Based on the available evidence, the addition of surgery to thoracic locally advanced esophageal carcinoma patients with a cCR after neoadjuvant CRT provided no advantage to long-term survival. As an exception, the two-year DFS and OS could be improved. This research conclusion might be more suitable to patients with squamous cell carcinoma.