Nine RCTs (n=1,116) were included.
The quality scores of the RCTs ranged from 1 to 3 (on a 5-point scale), with a mean of 2.1.
Survival of the two patient groups was similar at 1 year (OR 0.79, 95% confidence interval, CI: 0.59, 1.06) and 2 years (OR 0.77, 95% CI: 0.56, 1.05), but 3-year survival was statistically significantly superior in the chemoradiation plus surgery group compared with the surgery alone group (OR 0.66, 95% CI: 0.47, 0.92).
Patients treated with surgery alone were more likely to undergo oesophageal resection than patients treated with chemoradiation plus surgery (OR 2.5, 95% CI: 1.05, 5.96), but were less likely to have complete resection (OR 0.53, 95% CI: 0.33, 0.84).
When the analysis was limited to studies of squamous cancer, the 3-year survival advantage of neoadjuvent chemotherapy and surgery was less apparent (OR 0.75, 95% CI: 0.52, 1.09). The analysis could not be limited to adenocarcinoma as there was only one trial of this type.
In a subgroup analysis of RCTs using concurrent chemoradiation, 3-year survival strongly favoured chemoradiation plus surgery (OR 0.45, 95% CI: 0.26, 0.79). No significant difference between treatments was seen on this oucome for RCTs of sequential radiation (OR 0.82, 95% CI: 0.54, 1.25).
Patients receiving neoadjuvent chemotherapy and surgery had fewer local-regional cancer recurrences (OR 0.38, 95% CI: 0.23, 0.63). Distant recurrence (OR 0.88, 95% CI: 0.55, 1.41) and all cancer recurrence (OR 0.47, 95% CI: 0.16, 1.45) were similar for both patient groups.
There was a non significant trend in favour of surgery alone for both operative mortality (OR 1.72, 95% CI: 0.96, 3.07) and all treatment mortality (OR 1.63, 95% CI: 0.99, 2.68).