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SCI, CBM Database, CNKI Database, VIP Database and Wanfang Database were searched to identify all published or unpublished RCTs those compared neoadjuvant chemotherapy plus surgery with surgery alone for resectable esophageal neoplasms up to August 1, 2015.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.
ObjectiveTo provide clinical reference for the perioperative management of esophageal cancer patients with different stages of chronic obstructive pulmonary disease (COPD) through investigating the impact of COPD on postoperative complications and survival in esophageal cancer patients undergoing oesophagectomy.MethodsThe clinical data of 163 patients who underwent radical resection of esophageal cancer in our department from January 2015 to January 2018 were retrospectively analyzed, including 124 males and 39 females, with a median age of 64 years (IQR: 23.8 years). They were divided into a COPD group (n=87) and a non-COPD group (n=76) according to the presence of COPD before operation. The clinical data were collected and the postoperative complications and 2-year survival between the two groups were compared and analyzed.ResultsThe incidence of major postoperative complications (pulmonary infection, respiratory failure, arrhythmia and anastomotic leakage) in the COPD group were higher than those in the non-COPD group (all P<0.05). Spearman correlation analysis showed that the severity of preoperative COPD was positively correlated with the incidence of postoperative complications in patients with esophageal cancer (r=0.437, P<0.001). The incidence of postoperative respiratory failure and mortality in patients with severe COPD were significantly higher than those in patients without COPD and those with mild or moderate COPD. The 2-year survival rate of patients with esophageal cancer in the COPD group was lower than that in the non-COPD group (56.1% vs. 78.5.%, P=0.001), and the severity of COPD was negatively correlated to the survival rate.ConclusionCOPD significantly increases the incidence of postoperative complications in patients with esophageal cancer, which is not conducive to the prognosis of patients, and the severity of COPD is correlated with postoperative complications and 2-year survival rate.
ObjectiveTo systematically evaluate the efficacy and safety of nedaplatin versus cisplatin combined with fluorouracil in the treatment of esophageal neoplasms.MethodsPubMed, EMbase, Web of Science, The Cochrane Library, CNKI, WanFang, VIP and CBM databases were searched by computer to investigate the randomized controlled studies about the clinical effects of nedaplatin combined with fluorouracil versus cisplatin combined with fluorouracil in the treatment of esophageal neoplasms. The retrieval time was from the establishment of the database to January 2021. And meta-analysis was performed using RevMan 5.4.ResultsA total of 12 randomized controlled studies involving 744 patients were included. The results of meta-analysis showed that the total effective rate of the nedaplatin group was better than that of the cisplatin group (P<0.05). The incidence of nausea, vomiting, diarrhea and renal impairment in the nedaplatin group was lower than that in the cisplatin group (P<0.05), but the incidence of leukopenia and hemoglobin decline was higher than that in the cisplatin group (P<0.05). There was no statistical difference in the incidence of liver injury, or platelet decline between the two groups (P>0.05).ConclusionNedaplatin combined with fluorouracil has more advantages than cisplatin combined with fluorouracil in the treatment of esophageal cancer, the incidence of nausea, vomiting and diarrhea is lower, and the damage to kidney function is also smaller.
Objective To systematically evaluate the short-term efficacy and safety of McKeown and Sweet methods in the treatment of esophageal cancer. Methods PubMed, EMbase, The Cochrane Library, Web of Science, Wanfang, VIP, CNKI and China General Library of Biomedical Literature were searched for literature on the short-term efficacy and safety of McKeown and Sweet methods in the treatment of esophageal cancer published from the establishment to May 2023. Newcastle-Ottawa Scale was used to evaluate the quality of researches, and meta-analysis was performed using RevMan5.4. Results A total of 9 articles were included, involving 3687 patients including 1019 in the McKeown group and 2668 in the Sweet group. NOS score was 8-9 points. There were no statistical differences in the age, sex or American Joint Committee on Cancer stage between the two groups (P>0.05). Patients in the McKeown group had longer operative time and hospital stay, more intraoperative blood loss, and higher Eastern Cooperative Oncology Group scores than those in the Sweet group (P<0.05). However, the McKeown operation could remove more lymph nodes. In terms of safety, the incidences of pulmonary complications [OR=2.20, 95%CI (1.40, 3.46), P＜0.001] and postoperative anastomotic leakage [OR=2.06, 95%CI (1.45, 2.92), P＜0.001] were higher in the McKeown group than those in the Sweet group. In addition, there were no statistical differences between the two groups in the Karnofsky score, cardiac complications, vocal cord injury or paralysis, chylous leakage, or gastric emptying (P>0.05). Conclusion Compared with McKeown, Sweet method has advantages in operation time, intraoperative blood loss and hospital stay, and had lower incidence of postoperative pulmonary complications and anastomotic leakage. However, McKeown has more lymph node dissection.
Objective To compare the short-term efficacy and safety of inflatable video-assisted mediastinoscopic transhiatal esophagectomy (IVMTE) and minimally invasive transthoracic esophagectomy (MITE) in the treatment of esophageal cancer. MethodsThe Cochrane Library, EMbase, PubMed, Wanfang Database, VIP, and CNKI were searched. Literatures related to the short-term efficacy and safety of IVMTE and MITE in the treatment of esophageal neoplasms published from the establishment of the database to December 2023 were searched and meta-analysis was conducted by using RevMan5.4. Quality of case control study or cohort study was assessed by the Newcastle-Ottawa Scale (NOS) and quality of randomized controlled trial was assessed by Cochrane Handbook. Results A total of 14 studies (12 case control studies and 1 prospective cohort study wiht NOS score more than 7 points and 1 randomized controlled trial wiht low bias risk) were included, comprising 1 163 patients, with 525 in the IVMTE group and 638 in the MITE group. The results of meta-analysis revealed that the IVMTE group exhibited significantly shorter operative time [MD=−60.42, 95%CI (−83.78, −37.07), P<0.001] and postoperative hospital stay [MD=−2.44, 95%CI (−2.93, −1.94), P<0.01] compared to the MITE group. Moreover, intraoperative blood loss [MD=−34.67, 95%CI (−59.11, −10.23), P=0.005], three-day postoperative drainage [MD=−286.66, 95%CI (−469.93, −103.40), P=0.002], incidence of postoperative pulmonary infection [OR=0.38, 95%CI (0.26, 0.56), P<0.001], lung leakage rate [OR=0.12, 95% CI (0.02, 0.63), P=0.01] and overall complication rate [MD=0.41, 95%CI (0.22, 0.75), P=0.004] were all lower in the IVMTE group compared to those in the MITE group. However, the MITE technique demonstrated superiority over IVMTE regarding intraoperative lymph dissection number [MD=−3.52, 95%CI (−6.36, –0.68), P=0.02] and intraoperative recurrent laryngeal nerve injury [OR=1.78, 95%CI (1.22, 2.60), P=0.003]. No significant difference was observed between both methods concerning anastomotic fistula. Conclusion Compared to MITE, IVMTE has advantages such as shorter operation time, less intraoperative blood loss, shorter hospital stay, less postoperative drainage within 3 days, and a lower incidence of pulmonary complications. In terms of laryngeal recurrent nerve injury and lymphatic dissection, MITE operation offers more benefits.