Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for esophageal neoplasms: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YANG Zhenyu ¹ , ZHU Zewu ¹ , ALAI Guha ¹ ,  CHEN Longqi ^1,2

1. West China School of Medicine, Sichuan University, Chengdu, 610041, P.R.China;
2. Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, 610041, P.R.China;

Corresponding author：

CHEN Longqi, Email: drchenlq@gmail.com

Keywords：

Neoadjuvant chemotherapy; surgery alone; resectable esophageal neoplasms; meta-analysis

DOI：

10.7507/1007-4848.201604050

Video：

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Objective To evaluate the efficacy and safety of neoadjuvant chemotherapy (a CRTS group) plus surgery versus surgery alone (a SA group) in the treatment of resectable esophageal neoplasms. Methods PubMed, Ovid Technologies, SCI, CBM Database, CNKI Database, VIP Database and Wanfang Database were searched to identify all published or unpublished RCTs those compared neoadjuvant chemotherapy plus surgery with surgery alone for resectable esophageal neoplasms up to August 1, 2015. Meta-analysis was conducted by using Stata12.0 software. Results Twenty-six RCTs included 3 252 patients (1 606 in the CRTS group, 1 646 in the SA group) were selected. There was a significant difference between the CRTS group and the SA group in 3-year survival rate, 5-year survival rate, R0 resection rate, local recurrence rate, local recurrence and distant metastasis rate with relative risk (RR) value and 95%CI at 1.24 (1.13–1.36, P<0.000 1), 1.29 (1.10–1.50,P=0.001), 1.13 (1.05–1.212, P=0.001), 0.67 (0.52–0.85, P=0.001), 0.60 (0.40–0.90, P=0.013). And there was no significant difference between the CRTS group and the SA group in 1-year survival rate and distant metastasis with RR (95%CI) of 1.05 (0.99–1.12, P=0.103) and 0.84 (0.70–1.00, P=0.053). There was no significant difference in postoperative complications, 30-days mortality, pulmonary infections, anastomotic leakage, anastomotic stricture, cardiac complications, chylothorax between the two groups with RR (95%CI) at 1.09 (0.96–1.24, P=0.166), 1.32 (0.96–1.83, P=0.485), 1.45 (0.94–2.23, P=0.091), 0.89 (0.63–1.25, P=0.485), 0.93 (0.64–1.35, P=0.731), 1.24(0.84–1.87, P=0.283), and 1.62 (0.85–3.07, P=0.142). Conclusion CRTS significantly benefits to survival rate, R0 rescetion rate, and local recurrence rate compared to SA. Additionally there is no increased postoperative complication for patients with resectable esophageal neoplasms.

Citation： YANG Zhenyu, ZHU Zewu, ALAI Guha, CHEN Longqi. Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for esophageal neoplasms: A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(11): 867-879. doi: 10.7507/1007-4848.201604050 Copy

1.	Fitzmaurice C, Dicker D, Pain A, et al. The global burden of cancer 2013. JAMA Oncol, 2015, 1(4): 505-527.
2.	Saglam EK, Kilciksiz S, Ozseker N, et al. Treatment outcome and prognostic factors in non-metastatic esophageal carcinoma. Saudi Med J, 2007, 28(7): 1086-1090.
3.	Nygaard K, Hagen S, Hansen HS, et al. Pre-operative radiotherapy prolongs survival in operable esophageal carcinoma: a randomized, multicenter study of pre-operative radiotherapy and chemotherapy. The second Scandinavian trial in esophageal cancer. World J Surg, 1992, 16(6): 1104-1110.
4.	Apinop C, Puttisak P, Preecha N. A prospective study of combined therapy in esophageal cancer. Hepatogastroenterology, 1994, 41(4): 391-393.
5.	Le Prise E, Etienne PL, Meunier B, et al. A randomized study of chemotherapy,radiation therapy, and surgery versus surgery forlocalized squamous cell carcinoma of the esophagus. Cancer, 1994, 73(7): 1779-1784.
6.	Walsh TN, Noonan N, Hollywood D, et al. A comparison of multimodal therapy and surgery for esophageal adenocarcinoma. N Engl J Med, 1996, 335(7): 462-467.
7.	Bosset JF, Gignoux M, Triboulet JP, et al. Chemoradiotherapy followed by surgery compared with surgery alone in squamous-cell cancer of the esophagus. N Engl J Med, 1997, 337(3): 161-167.
8.	Urba SG, Orringer MB, Turrisi A, et al. Randomized trial of preoperative chemoradiation versus surgery alone in patients with locoregional esophageal carcinoma. J Clin Oncol, 2001, 19(2): 305-313.
9.	安丰山, 黄金球, 谢映涛, 等. 食管癌新辅助放化疗的前瞻性临床研究. 中华肿瘤杂志, 2003, 25(4): 376-379.
10.	Lee JL, Park SI, Kim SB, et al. A single institutional phase III trial of preoperative chemotherapy with hyperfractionation radiotherapy plus surgery versus surgery alone for resectable esophageal squamous cell carcinoma. Ann Oncol, 2004, 15(6): 947-954.
11.	Burmeister BH, Smithers BM, Gebski V, et al. Surgery alone versus chemoradiotherapy followed by surgery for resectable cancer of the oesophagus: arandomised controlled phase III trial. Lancet Oncol, 2005, 6(9): 659-668.
12.	Natsugoe S, Okumura H, Matsumoto M, et al. Randomized controlled study on preoperative chemoradiotherapy followed by surgery versus surgery alone for esophageal squamous cell cancer in a single institution. Dis Esophagus, 2006, 19(6): 468-472.
13.	曹秀峰, 王山, 吴必超, 等. 新辅助放化疗对中晚期食管鳞癌病理分期及预后的影响. 世界华人消化杂志, 2007, 15(22): 2413-2417.
14.	刘钊. 术前辅助放化疗治疗中晚期食管癌临床疗效分析. 中国误诊学杂志, 2007, 7(7): 1464.
15.	Tepper J, Krasna MJ, Niedzwiecki D, et al. Phase III trial of trimodality therapy withcisplatin, fluorouracil, radiotherapy, and surgery compared with surgery alone for esophageal cancer: CALGB 9781. J Clin Oncol, 2008, 26(7): 1086-1092.
16.	金明根, 姜盛春, 陈智文, 等. 术前同步放化疗与单纯手术治疗食管癌的临床对比观察. 中华肿瘤防治杂志, 2008, 15(23): 1815-1817.
17.	彭林, 谢天鹏, 韩泳涛, 等. 术前放化疗与单纯手术治疗食管鳞癌的随机对照研究. 肿瘤, 2008, 28(7): 620-622.
18.	Lv J, Cao XF, Zhu B, et al. Long term efficacy of perioperative chemoradiotherapyon esophageal squamous cell carcinoma. World J Gastroenterol, 2010, 16(13): 1649-1654.
19.	谢军, 崔继承, 王根彩. 新辅助放化疗在局部晚期食管癌治疗中的价值. 南通大学学报(医学版), 2010, 30(6): 488, 490.
20.	张文山, 潘开云, 蔡志仕, 等. 术前同期放化疗并手术治疗局部晚期食管癌的前瞻性临床研究. 中国肿瘤外科杂志, 2011, 3(5): 266-268.
21.	金芳玲, 胡祖良, 马海锋, 等. 新辅助放化疗联合手术与单纯手术治疗局部晚期食管癌的疗效比较. 实用肿瘤杂志, 2011, 26(5): 523-526.
22.	van Hagen P, Hulshof MC, van Lanschot JJ, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med, 2012, 366(22): 2074-2084.
23.	杨弘, 傅剑华, 刘孟忠, 等. 术前放化疗并手术治疗局部晚期食管鳞癌的多中心随机对照临床研究. 中华医学杂志, 2012, 92(15): 1028-1032.
24.	王士忠, 刘立群, 杨兆禄, 等. 新辅助放化疗联合手术治疗Ⅲ期食管癌效果观察. 山东医药, 2012, 52(34): 49-50.
25.	Mariette C, Dahan L, Mornex F, et al. Surgery alone versus chemoradiotherapy followed by surgery for stage I and II esophageal cancer: final analysis of randomized controlled phase III trial FFCD 9901. J Clin Oncol, 2014, 32(23): 2416-2422.
26.	陆向东, 张汀荣. 新辅助放化疗联合手术治疗局部晚期食管癌的临床观察. 江苏医药, 2014, 40(16): 1936-1938.
27.	李孝鹏, 丁宁, 白光平, 等. 新辅助放化疗联合手术与单纯手术治疗局部晚期食管癌的疗效比较. 肿瘤防治研究, 2014, 41(5): 464-467.
28.	张强, 魏凌云, 杨清杰, 等. 新辅助放化疗并全腔镜手术治疗局部晚期食管鳞癌的临床研究. 临床军医杂志, 2014, 42(7): 688-690, 713.
29.	Kelly P, Appleyard V, Murray K, et al. Detection of oesophageal cancer biomarkers by plasmaproteomic profiling of human cell line xenografts in response to chemotherapy. Br J Cancer, 2010, 103(2): 232-238.
30.	Burmeister BH, Thomas JM, Burmeister EA, et al. Is concurrent radiation therapy required in patients receiving preoperative chemotherapy for adenocarcinoma of the oesophagus? A randomised phase II trial. Eur J Cancer, 2011, 47(3): 354-360.
31.	Stahl M, Walz MK, Stuschke M, et al. Phase III comparison of preoperative chemotherapy compared with chemoradiotherapy in patients with locally advanced adenocarcinoma of the esophagogastric junction. J Clin Oncol, 2009, 27(6): 851-856.
32.	Ando N, Kato H, Igaki H, et al. A randomized trial comparing postoperative adjuvant chemotherapy with cisplatin and 5-fluorouracil versus preoperative chemotherapy for localized advanced squamous cell carcinoma of the thoracic esophagus (JCOG9907). Ann Surg Oncol, 2012, 19(1): 68-74.
33.	Ancona E, Ruol A, Santi S, et al. Only pathologic complete response to neoadjuvant chemotherapy improves significantly the longterm survival of patients with resectable esophageal squamous cell carcinoma: final report of arandomized, controlled trial of preoperative chemotherapy versus surgery alone. Cancer, 2001, 91(11): 2165-2174.
34.	Urschel JD, Vasan H. A meta-analysis of randomized controlled trials that compared neoadjuvant chemoradiation and surgery to surgery alone for resectable esophageal cancer. Am J Surg, 2003, 185(6): 538-543.
35.	尉腊革. 新辅助放化疗对食管癌患者肺功能和术后肺部并发症的影响. 临床合理用药, 2014, 7(3): 97-98.
36.	Heidecke CD, Weighardt H, Feith M, et al. Neoadjuvant treatment of esophageal cancer: immunosuppression following combined radiochemotherapy. Surg, 2002, 132(3): 495-501.
37.	Wilke TJ, Bhirud AR, Lin C. A review of the impact of preoperative chemoradiotherapy on outcome and postoperative complications in esophageal cancer patients. Am J Clin Oncol, 2015, 38(4): 415-421.
38.	Fiorica F, Di Bona D, Schepis F, et al. Preoperative chemoradiotherapy for oesophageal cancer: a systematic review and meta-analysis. Gut, 2004, 53(7): 925-930.
39.	王亚梅, 王峰, 何炜, 等. 术前放化疗与单纯手术治疗可切除食管癌的 Meta 分析. 世界华人消化杂志, 2012, 20(32): 3140-3153.
40.	Deng J, Wang C, Xiang M, et al. Meta-analysis of postoperative efficacy in patients receiving chemoradiotherapy followed by surgery for resectable esophageal carcinoma. Diagn Pathol, 2014, 9: 151.
41.	Ferguson MK, Celauro AD, Prachand V. Prediction of major pulmonary complications after esophagectomy. Ann Thorac Surg, 2011, 91(5): 1494-1501.
42.	Riedel M, Stein HJ, Mounyam L, et al. Influence of simultaneous neoadjuvant radiotherapy and chemotherapy on bronchoscopic findins and lung function in patients with locally advanced proximal esophageal cancer. Am J Respir Crit Care Med, 2000, 162(5): 1741-1746.
43.	Morita M, Masuda T, Okada S, et al. Preoperative chemoradiotherapy for esophageal cancer: factors associated with clinical response and postoperative complications. Anticancer Res, 2009, 29(7): 2555-2562.
44.	Abou-Jawde RM, Mekhail T, Adelstein DJ, et al. Impact of induction concurrent chemoradiotherapy on pulmonary function and postoperative acute respiratory complications in esophageal cancer. Chest, 2005, 128(1): 250-255.
45.	Lin FC, Durkin AE, Ferguson MK. Induction therapy does not increase surgical morbidity after esophagectomy for cancer. Ann Thorac Surg, 2004, 78(5): 1783-1789.
46.	Juloori A, Tucker SL, Komaki R, et al. Influence of preoperative radiation field on postoperative leak rates in esophageal cancer patients after trimodality therapy. J Thorac Oncol, 2014, 9(4): 534-540.
47.	Cooke DT, Lin GC, Lau CL, et al. Analysis of cervical esophagogastric anastomotic leaks after transhiatal esophagectomy: risk factors, presentation, and detection. Ann Thorac Surg, 2009, 88(1): 177-185.
48.	Eguchi R, Ide H, Nakamura T, et al. Analysis of postoperative complications after esophagectomy for esophageal cancer in patients receiving neoadjuvant therapy. Jpn J Thorac Cardiovasc Surg, 1999, 47(11): 552-558.
49.	Koëter M, van der Sangen MJ, Hurkmans CW, et al. Radiation dose does not influence anastomotic complications in patients with esophageal cancer treated with neoadjuvant chemoradiation and transhiatal esophagectomy. Radiat Oncol, 2015, 6: 10: 59.
50.	Van Heijl M, Gooszen JA, Fockens P, et al. Risk factors for development of benign cervical strictures after esophagectomy. Ann Surg, 2010, 251(6): 1064-1069.
51.	Vande Walle C, Ceelen WP, Boterberg T, et al. Anastomotic complications after Ivor Lewis esophagectomy in patients treated with neoadjuvant chemoradiation are related to radiation dose to the gastric fundus. Int J Radiat Oncol Biol Phys, 2012, 82(3): e513-e519.

1. Fitzmaurice C, Dicker D, Pain A, et al. The global burden of cancer 2013. JAMA Oncol, 2015, 1(4): 505-527.
2. Saglam EK, Kilciksiz S, Ozseker N, et al. Treatment outcome and prognostic factors in non-metastatic esophageal carcinoma. Saudi Med J, 2007, 28(7): 1086-1090.
3. Nygaard K, Hagen S, Hansen HS, et al. Pre-operative radiotherapy prolongs survival in operable esophageal carcinoma: a randomized, multicenter study of pre-operative radiotherapy and chemotherapy. The second Scandinavian trial in esophageal cancer. World J Surg, 1992, 16(6): 1104-1110.
4. Apinop C, Puttisak P, Preecha N. A prospective study of combined therapy in esophageal cancer. Hepatogastroenterology, 1994, 41(4): 391-393.
5. Le Prise E, Etienne PL, Meunier B, et al. A randomized study of chemotherapy,radiation therapy, and surgery versus surgery forlocalized squamous cell carcinoma of the esophagus. Cancer, 1994, 73(7): 1779-1784.
6. Walsh TN, Noonan N, Hollywood D, et al. A comparison of multimodal therapy and surgery for esophageal adenocarcinoma. N Engl J Med, 1996, 335(7): 462-467.
7. Bosset JF, Gignoux M, Triboulet JP, et al. Chemoradiotherapy followed by surgery compared with surgery alone in squamous-cell cancer of the esophagus. N Engl J Med, 1997, 337(3): 161-167.
8. Urba SG, Orringer MB, Turrisi A, et al. Randomized trial of preoperative chemoradiation versus surgery alone in patients with locoregional esophageal carcinoma. J Clin Oncol, 2001, 19(2): 305-313.
9. 安丰山, 黄金球, 谢映涛, 等. 食管癌新辅助放化疗的前瞻性临床研究. 中华肿瘤杂志, 2003, 25(4): 376-379.
10. Lee JL, Park SI, Kim SB, et al. A single institutional phase III trial of preoperative chemotherapy with hyperfractionation radiotherapy plus surgery versus surgery alone for resectable esophageal squamous cell carcinoma. Ann Oncol, 2004, 15(6): 947-954.
11. Burmeister BH, Smithers BM, Gebski V, et al. Surgery alone versus chemoradiotherapy followed by surgery for resectable cancer of the oesophagus: arandomised controlled phase III trial. Lancet Oncol, 2005, 6(9): 659-668.
12. Natsugoe S, Okumura H, Matsumoto M, et al. Randomized controlled study on preoperative chemoradiotherapy followed by surgery versus surgery alone for esophageal squamous cell cancer in a single institution. Dis Esophagus, 2006, 19(6): 468-472.
13. 曹秀峰, 王山, 吴必超, 等. 新辅助放化疗对中晚期食管鳞癌病理分期及预后的影响. 世界华人消化杂志, 2007, 15(22): 2413-2417.
14. 刘钊. 术前辅助放化疗治疗中晚期食管癌临床疗效分析. 中国误诊学杂志, 2007, 7(7): 1464.
15. Tepper J, Krasna MJ, Niedzwiecki D, et al. Phase III trial of trimodality therapy withcisplatin, fluorouracil, radiotherapy, and surgery compared with surgery alone for esophageal cancer: CALGB 9781. J Clin Oncol, 2008, 26(7): 1086-1092.
16. 金明根, 姜盛春, 陈智文, 等. 术前同步放化疗与单纯手术治疗食管癌的临床对比观察. 中华肿瘤防治杂志, 2008, 15(23): 1815-1817.
17. 彭林, 谢天鹏, 韩泳涛, 等. 术前放化疗与单纯手术治疗食管鳞癌的随机对照研究. 肿瘤, 2008, 28(7): 620-622.
18. Lv J, Cao XF, Zhu B, et al. Long term efficacy of perioperative chemoradiotherapyon esophageal squamous cell carcinoma. World J Gastroenterol, 2010, 16(13): 1649-1654.
19. 谢军, 崔继承, 王根彩. 新辅助放化疗在局部晚期食管癌治疗中的价值. 南通大学学报(医学版), 2010, 30(6): 488, 490.
20. 张文山, 潘开云, 蔡志仕, 等. 术前同期放化疗并手术治疗局部晚期食管癌的前瞻性临床研究. 中国肿瘤外科杂志, 2011, 3(5): 266-268.
21. 金芳玲, 胡祖良, 马海锋, 等. 新辅助放化疗联合手术与单纯手术治疗局部晚期食管癌的疗效比较. 实用肿瘤杂志, 2011, 26(5): 523-526.
22. van Hagen P, Hulshof MC, van Lanschot JJ, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med, 2012, 366(22): 2074-2084.
23. 杨弘, 傅剑华, 刘孟忠, 等. 术前放化疗并手术治疗局部晚期食管鳞癌的多中心随机对照临床研究. 中华医学杂志, 2012, 92(15): 1028-1032.
24. 王士忠, 刘立群, 杨兆禄, 等. 新辅助放化疗联合手术治疗Ⅲ期食管癌效果观察. 山东医药, 2012, 52(34): 49-50.
25. Mariette C, Dahan L, Mornex F, et al. Surgery alone versus chemoradiotherapy followed by surgery for stage I and II esophageal cancer: final analysis of randomized controlled phase III trial FFCD 9901. J Clin Oncol, 2014, 32(23): 2416-2422.
26. 陆向东, 张汀荣. 新辅助放化疗联合手术治疗局部晚期食管癌的临床观察. 江苏医药, 2014, 40(16): 1936-1938.
27. 李孝鹏, 丁宁, 白光平, 等. 新辅助放化疗联合手术与单纯手术治疗局部晚期食管癌的疗效比较. 肿瘤防治研究, 2014, 41(5): 464-467.
28. 张强, 魏凌云, 杨清杰, 等. 新辅助放化疗并全腔镜手术治疗局部晚期食管鳞癌的临床研究. 临床军医杂志, 2014, 42(7): 688-690, 713.
29. Kelly P, Appleyard V, Murray K, et al. Detection of oesophageal cancer biomarkers by plasmaproteomic profiling of human cell line xenografts in response to chemotherapy. Br J Cancer, 2010, 103(2): 232-238.
30. Burmeister BH, Thomas JM, Burmeister EA, et al. Is concurrent radiation therapy required in patients receiving preoperative chemotherapy for adenocarcinoma of the oesophagus? A randomised phase II trial. Eur J Cancer, 2011, 47(3): 354-360.
31. Stahl M, Walz MK, Stuschke M, et al. Phase III comparison of preoperative chemotherapy compared with chemoradiotherapy in patients with locally advanced adenocarcinoma of the esophagogastric junction. J Clin Oncol, 2009, 27(6): 851-856.
32. Ando N, Kato H, Igaki H, et al. A randomized trial comparing postoperative adjuvant chemotherapy with cisplatin and 5-fluorouracil versus preoperative chemotherapy for localized advanced squamous cell carcinoma of the thoracic esophagus (JCOG9907). Ann Surg Oncol, 2012, 19(1): 68-74.
33. Ancona E, Ruol A, Santi S, et al. Only pathologic complete response to neoadjuvant chemotherapy improves significantly the longterm survival of patients with resectable esophageal squamous cell carcinoma: final report of arandomized, controlled trial of preoperative chemotherapy versus surgery alone. Cancer, 2001, 91(11): 2165-2174.
34. Urschel JD, Vasan H. A meta-analysis of randomized controlled trials that compared neoadjuvant chemoradiation and surgery to surgery alone for resectable esophageal cancer. Am J Surg, 2003, 185(6): 538-543.
35. 尉腊革. 新辅助放化疗对食管癌患者肺功能和术后肺部并发症的影响. 临床合理用药, 2014, 7(3): 97-98.
36. Heidecke CD, Weighardt H, Feith M, et al. Neoadjuvant treatment of esophageal cancer: immunosuppression following combined radiochemotherapy. Surg, 2002, 132(3): 495-501.
37. Wilke TJ, Bhirud AR, Lin C. A review of the impact of preoperative chemoradiotherapy on outcome and postoperative complications in esophageal cancer patients. Am J Clin Oncol, 2015, 38(4): 415-421.
38. Fiorica F, Di Bona D, Schepis F, et al. Preoperative chemoradiotherapy for oesophageal cancer: a systematic review and meta-analysis. Gut, 2004, 53(7): 925-930.
39. 王亚梅, 王峰, 何炜, 等. 术前放化疗与单纯手术治疗可切除食管癌的 Meta 分析. 世界华人消化杂志, 2012, 20(32): 3140-3153.
40. Deng J, Wang C, Xiang M, et al. Meta-analysis of postoperative efficacy in patients receiving chemoradiotherapy followed by surgery for resectable esophageal carcinoma. Diagn Pathol, 2014, 9: 151.
41. Ferguson MK, Celauro AD, Prachand V. Prediction of major pulmonary complications after esophagectomy. Ann Thorac Surg, 2011, 91(5): 1494-1501.
42. Riedel M, Stein HJ, Mounyam L, et al. Influence of simultaneous neoadjuvant radiotherapy and chemotherapy on bronchoscopic findins and lung function in patients with locally advanced proximal esophageal cancer. Am J Respir Crit Care Med, 2000, 162(5): 1741-1746.
43. Morita M, Masuda T, Okada S, et al. Preoperative chemoradiotherapy for esophageal cancer: factors associated with clinical response and postoperative complications. Anticancer Res, 2009, 29(7): 2555-2562.
44. Abou-Jawde RM, Mekhail T, Adelstein DJ, et al. Impact of induction concurrent chemoradiotherapy on pulmonary function and postoperative acute respiratory complications in esophageal cancer. Chest, 2005, 128(1): 250-255.
45. Lin FC, Durkin AE, Ferguson MK. Induction therapy does not increase surgical morbidity after esophagectomy for cancer. Ann Thorac Surg, 2004, 78(5): 1783-1789.
46. Juloori A, Tucker SL, Komaki R, et al. Influence of preoperative radiation field on postoperative leak rates in esophageal cancer patients after trimodality therapy. J Thorac Oncol, 2014, 9(4): 534-540.
47. Cooke DT, Lin GC, Lau CL, et al. Analysis of cervical esophagogastric anastomotic leaks after transhiatal esophagectomy: risk factors, presentation, and detection. Ann Thorac Surg, 2009, 88(1): 177-185.
48. Eguchi R, Ide H, Nakamura T, et al. Analysis of postoperative complications after esophagectomy for esophageal cancer in patients receiving neoadjuvant therapy. Jpn J Thorac Cardiovasc Surg, 1999, 47(11): 552-558.
49. Koëter M, van der Sangen MJ, Hurkmans CW, et al. Radiation dose does not influence anastomotic complications in patients with esophageal cancer treated with neoadjuvant chemoradiation and transhiatal esophagectomy. Radiat Oncol, 2015, 6: 10: 59.
50. Van Heijl M, Gooszen JA, Fockens P, et al. Risk factors for development of benign cervical strictures after esophagectomy. Ann Surg, 2010, 251(6): 1064-1069.
51. Vande Walle C, Ceelen WP, Boterberg T, et al. Anastomotic complications after Ivor Lewis esophagectomy in patients treated with neoadjuvant chemoradiation are related to radiation dose to the gastric fundus. Int J Radiat Oncol Biol Phys, 2012, 82(3): e513-e519.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for esophageal neoplasms: A systematic review and meta-analysis

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