Evidence
This page contains a snapshot of featured content which highlights evidence addressing key clinical questions including areas of uncertainty. Please see the main topic reference list for details of all sources underpinning this topic.
BMJ Best Practice evidence tables
Evidence tables provide easily navigated layers of evidence in the context of specific clinical questions, using GRADE and a BMJ Best Practice Effectiveness rating. Follow the links at the bottom of the table, which go to the related evidence score in the main topic text, providing additional context for the clinical question. Find out more about our evidence tables.
This table is a summary of the analysis reported in a Cochrane Clinical Answer that focuses on the above important clinical question.
Confidence in the evidence is moderate or low to moderate where GRADE has been performed and there is a trade off between benefits and harms of the intervention.
Population: Adults with resectable thoracic oesophageal cancer
Intervention: Preoperative chemotherapy
Comparison: Surgery alone
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (GRADE)? |
|---|---|---|
Overall survival (follow‐up: 5 years) | Favours intervention | Moderate |
Overall rate of resections | No statistically significant difference | GRADE assessment not performed for this outcome |
Complete resections | Favours intervention | Moderate |
Local–regional recurrence (follow‐up: 5 years) | No statistically significant difference | Moderate |
Distant recurrence (follow‐up: 5 years) | No statistically significant difference | Moderate |
Local and distant recurrence | No statistically significant difference | GRADE assessment not performed for this outcome |
Response to chemotherapy | Unknown effectiveness ᵃ | GRADE assessment not performed for this outcome |
Quality of life | Unknown effectiveness ᵇ | GRADE assessment not performed for this outcome |
Morbidity: anastomotic leaks (follow‐up 30 days) ᶜ | No statistically significant difference | Moderate |
Note The Cochrane Clinical Answer (CCA) states that while there is moderate-quality evidence for overall 5-year survival and complete resections with preoperative chemotherapy, this may be offset by the risk of toxicity and possible increase in the rate of surgical complications. This is reflected in the overall rating in this table. The CCA also notes that caution is required when interpreting results for a variety of reasons (between-study heterogeneity; tumour histological type not being considered as a subgroup covariate; quality-of-life assessment focusing on dysphagia only). The Cochrane review which this CCA is based upon states that ultimately the decision to use preoperative chemotherapy should be made by the clinician and patient together and will depend on numerous factors such as survival, toxicity, quality of life, and cost of treatment. ᵃ Results reported narratively (nine RCTs with 1121 people; clinical response rate ranged from 19% to 57% across studies; complete pathological response ranged from 0% to 13% across eight trials). ᵇ Results reported narratively (one RCT with 802 people; reported a non-validated survey on dysphagia with 28% of participants in the chemotherapy group and 27% in the surgery group with improvement in dysphagia at one year). ᶜ Morbidity was also reported for postoperative deaths and pulmonary, cardiac, gastrointestinal, and infectious complications. However, there was no statistically significant difference and GRADE assessment was not performed for any of these outcomes.
This evidence table is related to the following section/s:
Cochrane Clinical Answers
Cochrane Clinical Answers (CCAs) provide a readable, digestible, clinically focused entry point to rigorous research from Cochrane systematic reviews. They are designed to be actionable and to inform decision making at the point of care and have been added to relevant sections of the main Best Practice text.
- In people with esophageal cancer, how does laparoscopic compare with open transhiatal esophagectomy at improving outcomes?
- Is there randomized controlled trial evidence to support the use of preoperative chemotherapy in people with resectable thoracic esophageal cancer?
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