P1.193. Neoadjuvant Therapies vs Upfront Surgery for cT2N0 Oesophageal Cancer – a Systematic Review and Meta-Analysis

Abstract

Esophageal Cancer: Surgical Treatment of Esophageal Cancer In March 2026, the International Society for Diseases of the Esophagus (ISDE) made ‘conditional’ recommendations in support of neoadjuvant therapy (NAT) over primary surgical resection (PSR) for patients diagnosed with cT2N0 oesophageal cancer. Notwithstanding this, controversial exists due to potential overtreatment. Our aim was to perform a systematic review and meta-analysis to evaluate oncological and survival outcomes in patients with cT2N0 oesophageal cancer who have undergone NAT and PSR. A systematic review was performed as per PRISMA guidelines. RevMan v5.4 was used for meta-analyses, with both Haenszel-Mantel and generic inverse methodology deployed. Overall survival (OS) and disease-free survival (DFS) represented the primary outcome measures. Overall, 8 studies were included. At meta-analysis, a non-significant difference was observed for OS (hazard ratio (HR): 1.03, 95% confidence interval (CI): 0.79-1.34, p=0.81) and DFS (HR: 1.13, 95% CI: 0.51 – 2.54, p=0.76) respectively. Moreover, no significant difference was observed in 3-year OS (odds ratio (OR): 0.91, 95% CI:P 0.73-1.12, p=0.35), with a significant improvement in 5-year OS observed in favour of surgery only cohort (OR: 1.35, 95% CI 1.01-1.80, p=0.04). This meta-analysis adds to the discussion on the curative management of c T2N0 disease with substantive evidence challenging the perception that NAT confers improved survival outcomes caveated by nuances of ongoing challenges in accurately staging the disease. The first generation of prospective, randomized clinical trials may confirm or refute these findings.