Impact of Surgery Timing After Neoadjuvant Therapy on Postoperative Outcomes and Long-Term Survival in Esophageal Carcinoma: A Quantitative Comparative Analysis

Background In treating locally advanced esophageal carcinoma (EC), neoadjuvant therapy followed by surgery represents a key approach. However, the timing of surgery following neoadjuvant therapy in EC remains controversial. Methods We conducted a systematic search of PubMed, EMBASE, Web of Science, and Cochrane Library for studies published up to August 1, 2024. Studies that compared delayed versus early surgery for locally advanced EC following neoadjuvant therapy were included. A fixed-effects or random-effects model was used based on heterogeneity. Results A meta-analysis of 23 studies involving 7721 EC patients found that delayed surgery was linked to higher anastomotic leakage (OR = 1.39, P = 0.007), lower R0 resection rates (OR = 0.59, P < 0.001), and poorer long-term OS (HR = 1.14, P = 0.02). No significant differences were observed in pulmonary complications, perioperative mortality, pCR rates, chylothorax, RLN injury, or cardiovascular complications. DFS also showed no significant difference between early and delayed surgery groups. These findings suggest delayed surgery may adversely impact surgical and long-term survival outcomes in EC patients. Conclusion While delayed surgery after neoadjuvant therapy in EC patients may be associated with a higher risk of anastomotic leaks and a lower rate of R0 resection, its impact on long-term survival remains an area of ongoing investigation. Future randomized controlled trials are needed to further clarify the optimal timing of surgery and identify potential benefits of delaying surgery in certain patients.