Adding esophagectomy to chemoradiotherapy in locally advanced esophageal squamous cell carcinoma has little or no impact on overall survival, according to a Cochrane review of 2 randomized trials involving 431 individuals. Moreover, it may be linked with higher treatment-related mortality. Among the findings:

• Adding surgery reduced the risk that cancer would come back at the primary site.
• It did not improve overall survival.
• There were more treatment-related deaths in patients who underwent surgery, vs those who didn’t.

The authors noted that adding esophagectomy probably delays locoregional relapse, but this end point was not well defined. They added that it is not known if these results can be applied to the treatment of adenocarcinomas, tumors of the distal esophagus and gastroesophageal junction, or to those who respond poorly to chemoradiation.