Conversion surgery after induction therapy improves 5-year survival to 26.5% versus 11.6% in cT4 esophageal cancer patients

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European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology Published June 6, 2026 Medically reviewed June 6, 2026 Study authors: Jiang Kai-Yuan, Zhang Lu-Dan, Zhong Ai-Ling, Hu Wen-Long, Wang Jun-Jie, Zhang Jun-Jie, Mao Yu-Yang, … PubMed ↗ DOI ↗ By Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

Key Takeaway

Note that conversion surgery improves 5-year survival to 26.5% versus 11.6% in cT4 esophageal cancer.

This systematic review and meta-analysis assesses the impact of conversion surgery following induction therapy compared to definitive therapy in patients with cT4 esophageal cancer. The analysis included a total sample size of 3721 patients across the included studies. The primary outcome measured was overall survival at one, three, and five years.

Results indicate significantly better survival for the conversion surgery group. At one year, overall survival was 73.6% versus 49.6% for definitive therapy. At three years, survival was 37.0% versus 18.4%. At five years, survival was 26.5% versus 11.6%. In the cT4b subgroup, one-year survival was 86.4% versus 37.6%, and three-year survival was 48.6% versus 11.4%.

The authors highlight that the survival benefit of conversion surgery for cT4b disease requires further validation in larger prospective studies. Safety data and adverse events were not reported in this review. The certainty of the evidence was not reported. Clinicians should interpret these findings with caution regarding the cT4b subgroup until prospective data are available.

Study Details

Study typeMeta analysis

Sample sizen = 3,721

EvidenceLevel 1

Follow-up60.0 mo

PublishedJun 2026

PMID42001566

View Original Abstract ↓

BACKGROUND: cT4 esophageal cancer represents a major therapeutic challenge, with definitive chemoradiotherapy (dCRT) currently considered the standard treatment. However, survival outcomes remain unsatisfactory. CS following induction therapy has emerged as a potential alternative strategy, though its clinical effectiveness remains under debate. This systematic review and meta-analysis aimed to compare survival outcomes between conversion surgery (CS) and definitive therapy in patients with cT4 esophageal cancer. METHODS: Relevant literature was retrieved from PubMed, the Cochrane Library, and Embase. Patients were categorized into the CS group or the definitive therapy group. A systematic review and meta-analysis were performed to evaluate 1-, 3-, and 5-year overall survival (OS) outcomes in patients with esophageal cancer. Odds ratios, mean differences, and 95% confidence intervals were calculated using fixed-effects or random-effects models. RESULTS: Seventeen studies involving a total of 3721 patients with cT4 esophageal cancer were included. After excluding studies with high heterogeneity, CS was associated with significantly better survival compared to definitive therapy at 1-year (73.6% vs. 49.6%), 3-year (37.0% vs. 18.4%), and 5-year (26.5% vs. 11.6%) OS. A subgroup analysis of three studies including 341 patients with cT4b disease revealed a significant survival advantage for the CS group in both 1-year OS (86.4% vs. 37.6%) and 3-year OS (48.6% vs. 11.4%). CONCLUSIONS: CS following induction therapy significantly improves survival in patients with cT4 esophageal cancer. However, the survival benefit of CS for cT4b disease requires further validation in larger prospective studies.