Invited Commentary

Excerpt

The authors performed a prospective nonrandomized trial to evaluate the role of surgery secondary to chemoradiotherapy in patients with T4N0-1M0 esophageal cancer. They found significantly better survival in responders to chemoradiotherapy than in nonresponders and a better survival rate in the surgery group than in the nonsurgery group. They analyzed whether responders obtained any additional benefit by undergoing surgical resection compared with responders who did not, probably because performance of surgery after chemoradiotherapy was associated with a high rate of serious postoperative complications. They could not detect any benefit of surgical resection following chemoradiotherapy by comparing the survival curves of these two groups, although the 2- and 3-year survival rates were 55% and 37%, respectively, which were higher than the rates of 23% and 23%, respectively, in the nonsurgery group. The same analysis was done for nonresponders and showed no significant difference in survival between the surgery and nonsurgery groups, but the 1- and 2-year survival rates for the surgery group (64% and 33%, respectively) were considerably better than in the no-surgery group (20% and 20%, respectively). …