Prognostic benefit of surgery following chemoradiotherapy for squamous cell carcinoma of the oesophagus.

A best evidence topic in surgery was written according to a structured protocol. The question addressed was whether patients who have undergone chemoradiotherapy (CRT) for locally advanced squamous cell carcinoma of the oesophagus benefit from surgical resection. 505 papers were found using the reported search, of which 5 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group, study type, relevant outcomes and results of these papers are tabulated. Of these five studies, two were randomised controlled trials. These demonstrated that there was no survival benefit in adding surgery to patients who have undergone CRT for oesophageal cancer. The remaining three observational studies suggest that surgery may have a prognostic benefit for patients who show a partial, but not complete response to CRT. We conclude that for patients who are complete responders to induction CRT, surgery adds no survival benefit. With regard to partial responders there is weak evidence suggesting that there may be some benefit in surgery after CRT, but further trials are needed to clarify the survival benefit (if any) of adding oesophagectomy to CRT for this sub-group.