{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T11:21:16Z","timestamp":1785410476047,"version":"3.56.0"},"reference-count":83,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T00:00:00Z","timestamp":1779753600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"ISF","award":["2802\/22"],"award-info":[{"award-number":["2802\/22"]}]},{"award":["2802\/22"],"award-info":[{"award-number":["2802\/22"]}],"id":[{"id":"https:\/\/ror.org\/0120amd78","id-type":"ROR","asserted-by":"publisher"}]},{"name":"BSF","award":["2023129"],"award-info":[{"award-number":["2023129"]}]},{"award":["2023129"],"award-info":[{"award-number":["2023129"]}],"id":[{"id":"https:\/\/ror.org\/02a4k9d45","id-type":"ROR","asserted-by":"publisher"}]},{"name":"MOST","award":["5912"],"award-info":[{"award-number":["5912"]}]},{"award":["5912"],"award-info":[{"award-number":["5912"]}],"id":[{"id":"https:\/\/ror.org\/02b207r52","id-type":"ROR","asserted-by":"publisher"}]},{"DOI":"10.13039\/100001698","name":"ICRF","doi-asserted-by":"crossref","award":["81233611"],"award-info":[{"award-number":["81233611"]}],"id":[{"id":"10.13039\/100001698","id-type":"DOI","asserted-by":"crossref"}]},{"award":["81233611"],"award-info":[{"award-number":["81233611"]}],"id":[{"id":"https:\/\/ror.org\/02h43gk75","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background\/Objectives: Management of cervical esophageal cancer after induction therapy remains unsettled. Definitive chemoradiotherapy is the guideline default, but a subset of patients with residual but resectable disease may still benefit from surgery. No validated multidisciplinary selection framework exists for this subsite. Methods: We conducted a systematic review registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD420261369102) and guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement, using searches of PubMed\/MEDLINE, Web of Science, Scopus, and the Cochrane Library from inception through 14 April 2026. We identified 1779 records, removed 873 duplicates, and screened 906 records; 87 full-text reports were assessed, of which 67 were excluded at the full-text stage (66 on population grounds\u2014disease not cervical esophageal; and 1 because cervical-direct outcomes were not separable within a mixed cervical\/thoracic cohort), leaving 20 cervical-direct studies included in the primary synthesis. Thoracic and meta-analytic sources are cited for indirect comparison and biological rationale but are not counted in the included set. Included studies were evaluated using the Newcastle\u2013Ottawa Scale (NOS) and Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I); certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework. Formal meta-analysis was not performed because study design, treatment approach, and outcome reporting were too heterogeneous. Results: Cervical-specific evidence is predominantly retrospective but consistent in direction. Available cervical-specific observational data suggest benefit mainly in patients with biopsy-confirmed incomplete response, resectable residual disease, preserved performance status, and access to experienced centers. Larynx-preserving resection is feasible in 90% of T1\u20132 tumors and 54% of T3\u20134 responders. In thoracic esophageal squamous cell carcinoma, neoadjuvant chemoimmunotherapy yields pathologic complete response rates of approximately 29\u201348%; in cervical disease, the SCENIC trial has reported interim clinical response of approximately 50% in 28 patients, but pathology-confirmed response is not yet available. We present a proposed multidisciplinary selection framework integrating response depth, post-induction stage, laryngeal preservation feasibility, sarcopenia, circulating tumor DNA dynamics, and programmed death-ligand 1 (PD-L1) expression. The framework has not been prospectively validated and is presented as a hypothesis-generating, conceptual tool for multidisciplinary discussion rather than a clinically validated instrument. Adjuvant nivolumab is recommended for residual pathologic disease after margin-negative (R0) resection when surgery follows preoperative chemoradiotherapy; after PD-1-based induction, adjuvant checkpoint inhibition remains investigational. Conclusions: The available cervical-direct evidence is predominantly retrospective and selection-prone, and several inputs supporting the framework are extrapolated from thoracic ESCC cohorts; conclusions about the survival benefit of surgery should therefore be read as associations rather than causal claims. Surgery has a role after induction therapy in carefully selected incomplete responders. The proposed framework is designed for multidisciplinary use and requires prospective validation before routine clinical application.<\/jats:p>","DOI":"10.3390\/cancers18111736","type":"journal-article","created":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T13:28:21Z","timestamp":1779802101000},"page":"1736","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Surgery After Induction Therapy for Cervical Esophageal Cancer: A Systematic Review and Proposed Multidisciplinary Selection Framework"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7715-1825","authenticated-orcid":false,"given":"Ismaell","family":"Massalha","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, Ziv Medical Center, Safed 1300000, Israel"},{"name":"Faculty of Health Sciences, Ben-Gurion University, Beer Sheva 8410501, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adham","family":"Hijab","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Ziv Medical Center, Safed 1300000, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reem","family":"Zabit","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Ziv Medical Center, Safed 1300000, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bilal","family":"Krayim","sequence":"additional","affiliation":[{"name":"Helmsley Cancer Center, Shaare Zedek Medical Center, Jerusalem 9103102, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wael","family":"Hozaeel","sequence":"additional","affiliation":[{"name":"Legacy Heritage Oncology Center & Dr. Larry Norton Institute, Soroka University Medical Center, Beer Sheva 8410101, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moatz","family":"Safadi","sequence":"additional","affiliation":[{"name":"Department of Oncology, Ziv Medical Center, Safed 1300000, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samer","family":"Hussany","sequence":"additional","affiliation":[{"name":"Legacy Heritage Oncology Center & Dr. Larry Norton Institute, Soroka University Medical Center, Beer Sheva 8410101, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Israel","family":"Sandler","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Ziv Medical Center, Safed 1300000, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamal","family":"Zidan","sequence":"additional","affiliation":[{"name":"Department of Oncology, Ziv Medical Center, Safed 1300000, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ofir","family":"Cohen","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Ben-Gurion University, Beer Sheva 8410501, Israel"},{"name":"Faculty of Computer and Information Science, Ben-Gurion University of the Negev, Beer Sheva 8410501, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5304-7425","authenticated-orcid":false,"given":"Ory","family":"Wiesel","sequence":"additional","affiliation":[{"name":"Baruch Padeh-Tzafon Medical Center, Poriya 1528001, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1002\/jso.20795","article-title":"Surgical management of carcinoma of the cervical esophagus","volume":"96","author":"Daiko","year":"2007","journal-title":"J. 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