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Objective <p>This systematic review and meta-analysis aimed to evaluate the efficacy and safety of conversion surgery compared with non-surgical treatment in patients with initially unresectable esophageal cancer who underwent conversion therapy.</p> Methods <p>A comprehensive literature search was conducted across PubMed, Embase, Cochrane Library, and Web of Science through October 2025. Studies comparing conversion surgery versus non-surgical treatment following conversion therapy were included. Primary outcomes were overall survival (OS) and progression-free survival (PFS) at one, two, and three years. Risk ratios with 95% confidence intervals were pooled using random-effects models. Study quality was assessed using the Newcastle-Ottawa Scale.</p> Results <p>Ten studies comprising 973 patients (356 conversion surgery, 617 non-surgical treatment) were included. Conversion surgery was associated with significant improvements in OS at one year (RR = 1.53, 95% CI 1.34–1.76, <i>p</i> &lt; 0.001), two years (RR = 1.65, 95% CI 1.41–1.93, <i>p</i> &lt; 0.001), and three years (RR = 2.03, 95% CI 1.63–2.53, <i>p</i> &lt; 0.001). Similarly, conversion surgery demonstrated superior PFS at one year (RR = 1.77, 95% CI 1.31–2.40, <i>p</i> &lt; 0.001), two years (RR = 1.59, 95% CI 1.26–1.99, <i>p</i> &lt; 0.001), and three years (RR = 1.76, 95% CI 1.30–2.38, <i>p</i> &lt; 0.001). Common adverse events during conversion therapy included hematologic toxicities and radiation esophagitis, while postoperative complications in the surgical group primarily comprised respiratory complications, anastomotic leakage, and recurrent laryngeal nerve injury. No significant publication bias was detected.</p> Conclusions <p>Conversion surgery following effective conversion therapy is associated with significantly improved survival outcomes compared with continued non-surgical treatment in initially unresectable esophageal cancer. Treatment-related adverse events were manageable, with hematologic toxicities predominating during conversion therapy and surgical complications including anastomotic and respiratory issues.</p>

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Efficacy and Safety of Conversion Surgery Versus Non-Surgical Treatment for Initially Unresectable Esophageal Cancer: A Systematic Review and Meta-Analysis

  • 期刊论文

  • 发表日期：

    2026年3月23日

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  • Longhao Chen,
  • Jiuming Zhao,
  • Xinmei Luo

摘要

Objective

This systematic review and meta-analysis aimed to evaluate the efficacy and safety of conversion surgery compared with non-surgical treatment in patients with initially unresectable esophageal cancer who underwent conversion therapy.

Methods

A comprehensive literature search was conducted across PubMed, Embase, Cochrane Library, and Web of Science through October 2025. Studies comparing conversion surgery versus non-surgical treatment following conversion therapy were included. Primary outcomes were overall survival (OS) and progression-free survival (PFS) at one, two, and three years. Risk ratios with 95% confidence intervals were pooled using random-effects models. Study quality was assessed using the Newcastle-Ottawa Scale.

Results

Ten studies comprising 973 patients (356 conversion surgery, 617 non-surgical treatment) were included. Conversion surgery was associated with significant improvements in OS at one year (RR = 1.53, 95% CI 1.34–1.76, p < 0.001), two years (RR = 1.65, 95% CI 1.41–1.93, p < 0.001), and three years (RR = 2.03, 95% CI 1.63–2.53, p < 0.001). Similarly, conversion surgery demonstrated superior PFS at one year (RR = 1.77, 95% CI 1.31–2.40, p < 0.001), two years (RR = 1.59, 95% CI 1.26–1.99, p < 0.001), and three years (RR = 1.76, 95% CI 1.30–2.38, p < 0.001). Common adverse events during conversion therapy included hematologic toxicities and radiation esophagitis, while postoperative complications in the surgical group primarily comprised respiratory complications, anastomotic leakage, and recurrent laryngeal nerve injury. No significant publication bias was detected.

Conclusions

Conversion surgery following effective conversion therapy is associated with significantly improved survival outcomes compared with continued non-surgical treatment in initially unresectable esophageal cancer. Treatment-related adverse events were manageable, with hematologic toxicities predominating during conversion therapy and surgical complications including anastomotic and respiratory issues.