Survival after Multimodal Treatment Including Surgery for Metastatic Esophageal Cancer: A Systematic Review

SIMPLE SUMMARY: The management of stage IV esophageal cancer is mostly limited to palliative chemotherapy. In this context, the role and effects of surgery are still controversial. The aim of this systematic review is to assess the survival outcome of surgically treated metastatic esophageal cancer patients. Multimodality treatment, including surgery in curative intent, seems associated with a significant improvement of three years overall survival. Hence, a prospective evaluation of this approach and validation of adequate selection criteria are urgently needed. ABSTRACT: (1) Background: The management of metastatic esophageal cancer is more often limited to palliative chemotherapy. Limited data are available regarding the role of surgery that remains controversial. The aim of this systematic review is to assess the survival outcome of surgically treated metastatic esophageal cancer patients. (2) Methods: The present systematic review is designed using the PRISMA guidelines and has been registered with PROSPERO (CRD42019140306). Two reviewers independently searched and identified studies dealing with surgery for stage IV esophageal cancer in the Medline and Google Scholar databases between January 2008 and December 2019. (3) Results: Seven retrospective nonrandomized studies, totaling 1756 patients with stage IV esophageal cancer who underwent curative surgery, were included. Our analysis demonstrates a three-year overall survival rate of 23% (CI 95% 17–31) among patients undergoing surgery. Because only two comparative studies were identified, data compilation and relative risk evaluation through meta-analysis were not possible. (4) Conclusions: Multimodality treatment, including surgery in curative intent, seems associated with a significant chance of three-year overall survival. A prospective evaluation of this approach and validation of adequate selection criteria are needed.