Surgery After Induction Therapy for Cervical Esophageal Cancer: A Systematic Review and Proposed Multidisciplinary...

Area of Science:

• Oncology
• Surgical Oncology
• Systematic Review

Background:

• Management of cervical esophageal cancer post-induction therapy lacks a validated selection framework.
• Definitive chemoradiotherapy is standard, but surgery may benefit select patients with residual disease.

Purpose of the Study:

• To systematically review evidence for managing cervical esophageal cancer after induction therapy.
• To propose a multidisciplinary selection framework for identifying surgical candidates.

Main Methods:

• Systematic review of PubMed/MEDLINE, Web of Science, Scopus, and Cochrane Library (up to April 2026).
• Inclusion of 20 cervical-direct studies; evaluation using NOS, ROBINS-I, and GRADE frameworks.
• Development of a conceptual selection framework based on response depth, stage, and biomarkers.

Main Results:

• Cervical-specific evidence is retrospective, suggesting benefit for incomplete responders with resectable disease.
• Larynx-preserving resection is feasible in a majority of T1-2 tumors and half of T3-4 responders.
• A proposed framework integrates response, stage, feasibility, sarcopenia, ctDNA, and PD-L1 expression.

Conclusions:

• Surgery plays a role in carefully selected incomplete responders with cervical esophageal cancer.
• The proposed selection framework is a hypothesis-generating tool requiring prospective validation.
• Evidence for survival benefit of surgery is associative, not causal, due to study limitations.