• Berend J van der Wilk, Ben M Eyck, Wayne L Hofstetter, Jaffer A Ajani, Guillaume Piessen, Carlo Castoro, Rita Alfieri, Jong H Kim, Sung-Bae Kim, Heidi Furlong, Thomas N Walsh, Daan Nieboer, WijnhovenBas P LBPLDepartment of Surgery, Erasmus MC - University Medical Center, Erasmus MC Cancer Institute, Rotterdam, The Netherlands., Sjoerd M Lagarde, and LanschotJ Jan B vanJJBVDepartment of Surgery, Erasmus MC - University Medical Center, Erasmus MC Cancer Institute, Rotterdam, The Netherlands..
• Department of Surgery, Erasmus MC - University Medical Center, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
• Ann. Surg. 2022 Mar 1; 275 (3): 467476467-476.

ObjectiveTo compare overall survival of patients with a cCR undergoing active surveillance versus standard esophagectomy.Summary Of Background DataOne-third of patients with esophageal cancer have a pathologically complete response in the resection specimen after neoadjuvant chemoradiotherapy. Active surveillance may be of benefit in patients with cCR, determined with diagnostics during response evaluations after chemoradiotherapy.MethodsA systematic review and meta-analysis was performed comparing overall survival between patients with cCR after chemoradiotherapy undergoing active surveillance versus standard esophagectomy. Authors were contacted to supply individual patient data. Overall and progression-free survival were compared using random effects meta-analysis of randomized or propensity score matched data. Locoregional recurrence rate was assessed. The study-protocol was registered (PROSPERO: CRD42020167070).ResultsSeven studies were identified comprising 788 patients, of which after randomization or propensity score matching yielded 196 active surveillance and 257 standard esophagectomy patients. All authors provided individual patient data. The risk of all-cause mortality for active surveillance was 1.08 [95% confidence interval (CI): 0.62-1.87, P = 0.75] after intention-to-treat analysis and 0.93 (95% CI: 0.56-1.54, P = 0.75) after per-protocol analysis. The risk of progression or all-cause mortality for active surveillance was 1.14 (95% CI: 0.83-1.58, P = 0.36). Five-year locoregional recurrence rate during active surveillance was 40% (95% CI: 26%-59%). 95% of active surveillance patients undergoing postponed esophagectomy for locoregional recurrence had radical resection.ConclusionsOverall survival was comparable in patients with cCR after chemoradiotherapy undergoing active surveillance or standard esophagectomy. Diagnostic follow-up is mandatory in active surveillance and postponed esophagectomy should be offered to operable patients in case of locoregional recurrence.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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