Neoadjuvant therapy vs. surgery alone for esophageal squamous cell carcinoma undergoing thoracoscopic…

Cohort studyEuropean journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology· Jul 2026

Neoadjuvant therapy vs. surgery alone for esophageal squamous cell carcinoma undergoing thoracoscopic esophagectomy:An overlap weighting analysis.

Mengyao Zhang, Yanpeng Wu, Yi Zhang … Xiaocan Jia

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Esophageal SurgeryCohort studyTreatmentQ1IF 2.8

Neoadjuvant therapy did not improve overall survival vs surgery alone in esophageal cancer

Neoadjuvant therapy vs. surgery alone for esophageal squamous cell carcinoma undergoing thoracoscopic esophagectomy:An overlap weighting analysis.

Mengyao Zhang … Xiaocan Jia

European journal of surgical oncology · Jul 2026 · Q1 in Surgery

Background

The survival benefit of neoadjuvant therapy (neoadjuvant therapy) in patients with esophageal squamous cell carcinoma (esophageal squamous cell carcinoma) undergoing thoracoscopic esophagectomy (thoracoscopic esophagectomy) remains controversial.

Purpose

This study aims to evaluate the long-term survival impact of neoadjuvant therapy followed by surgery versus surgery alone (S-alone) in this population.

Methods

Were divided into the neoadjuvant therapy group (n = 269) and the S-alone group (n = 569).

n = 838 patients

Results

no survival difference between the two approaches

HR 0.98 (95% CI 0.72 to 1.35)

null 1

0.72

1.35

CI crosses the null - not significant

More results

The median OS for the entire cohort was 5.32 years, and the median DFS was 5.13 years.

After overlap weighting, all covariates were balanced between the groups.

Kaplan-Meier analysis with the log-rank test showed no statistically significant differences in 5-year OS or DFS between the two groups (P > 0.05).

More results

Subgroup analysis showed that neoadjuvant therapy was associated with a survival benefit in patients with clinically node-positive esophageal squamous cell carcinoma (P < 0.05).

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Conclusion · 1 of 3

Neoadjuvant therapy followed by surgery did not improve OS or DFS compared to S-alone in patients with esophageal squamous cell carcinoma undergoing thoracoscopic esophagectomy.

Conclusion · 2 of 3

However, subgroup analysis suggested a potential survival benefit for patients with more advanced disease.

Conclusion · 3 of 3

These findings support a stage-guided, individualized approach to neoadjuvant therapy in esophageal squamous cell carcinoma rather than its uniform application.

Neoadjuvant therapy vs. surgery alone for esophageal squamous cell carcinoma undergoing thoracoscopic esophagectomy:An overlap weighting analysis.

Neoadjuvant therapy vs. surgery alone for esophageal squamous cell carcinoma undergoing thoracoscopic esophagectomy:An overlap weighting analysis.

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