| Objectives: The purpose of this study is to perform a meta-analysis of randomized controlled trials(RCTs)that compared neoadjuvant chemotherapy and surgery with surgery alone for resectable oesophageal carcinoma, to expound comprehensively the curative effect of the current esophageal cancer preoperative treatment, to explore chemotherapy regimens and new chemotherapy drug selection about esophageal cancer preoperative adjuvant chemotherapy and radiotherapy.Methods: A systematic review of all the relevant randomized controlled trials(RCTs) was performed.Medline and manual searches was conducted in PubMed, ASCO(American Society of Clinical Oncology) meeting summary, Embase, the Cochrane Library (up to 2010), Chinese Biomedical Literature Database, China National Knowledge Infrastructure, VIP Database, Wanfang Database. The selection contents were to identify all published and unpublished RCTs that compared neoadjuvant chemotherapy (chemoradiotherapy) and surgery with surgery alone for resectable oesophageal carcinoma. Manual searches were performed by reviewing articles and abstracts cited in the published meta-analysis and RCTs. Two reviewers independently assessed trial eligibility,quality and extracted the data. The same two reviewers assessed the methodological quality of each trial by recording details of the randomization method, allocation concealment, blinding, whether an intention-to-treat analysis was possible from the published data and the number of patients who were lost to follow-up. The Peto method was used for analysis. Heterogeneity was analyzed by Meta-analysis using RevMan5.0.2 software.Results: By December 2010, 16 completed RCTs (include 2594 patients) met the inclusion criteria in neoadjuvant chemotherapy. The quality of all trials generally is high. Eight trials described details of the methods used, and eight trials provided information of allocation concealment, and five studies reported information of performing blinding between practitioners and participants, and five studies reported information of detailed follow-up data. Risk ratio (RR) (95% confidence interval [CI]; P value), expressed as neoadjuvant chemotherapy and surgery versus surgery alone (treatment versus control), was 1.02 (0.95, 1.10; P=0.54) for 1-year survival, 1.29 (1.13, 1.47; P =0.0001) for 3-year survival, 1.31 (1.13, 1.51; P =0.0003) for 5-year survival, 1.00 (0.95, 1.04; P=0.85) for rate of resection, 0.89 (0.64, 1.23; P=0.48) for operative mortality. The 13 completed RCTs (include 1574 patients) met the inclusion criteria in neoadjuvant chemoradiotherapy. Risk ratio (RR) (95% confidence interval [CI]; P value), expressed as neoadjuvant chemoradiotherapy and surgery versus surgery alone (treatment versus control), was 1.26 (1.00, 1.57; P=0.05) for 1-year survival, 1.38 (1.19, 1.61; P <0.0001) for 3-year survival, 1.34 (1.08, 1.65; P =0.007) for 5-year survival, 1.20 (1.13, 1.28; P<0.00001) for rate of resection, 1.60 (1.03, 2.49; P=0.04) for operative mortality, 1.09 (0.96, 1.24; P=0.20) for complication after surgery.Conclusion: Neoadjuvant chemotherapy for resectable esophageal carcinoma can improve the overall survival rate of patients with esophageal carcinoma, but it does not increase surgical risk and treatment related mortality. Neoadjuvant chemoradiotherapy significantly improved the overall survival and lowered rates of local recurrence of tumor in patients with esophageal cancer, but may increase the procedure-related complications and postoperative mortality. They are effective therapy methods of esophageal cancer, but we could not ignore the increased risk of postoperative mortality associated with neoadjuvant chemoradiotherapy in the treatment of esophageal cancer. This is worth of further studies in (chemoradiotherapy) chemotherapy regimens and new chemotherapy drug selection about esophageal cancer preoperative adjuvant therapy.
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