Most patients with advanced esophageal cancer have significant dysphagia, which contributes to weight loss and malnourishment. The majority of patients with esophageal cancer present with signs of malnutrition at the

time of diagnosis as a result of both dysphagia and tumor-induced cachexia (4). Additionally, patients undergoing multimodal therapy have been shown to have significantly worse nutritional parameters than those only undergoing resection (5). Radiation-induced esophagitis develops in 15-28% of treated patients’ further aggravating dysphagia (6,7). Also, the side effects of Inhibitors,research,lifescience,medical 5-fluorouracil and cisplatin, the most common chemotherapy regimen employed to treat esophageal cancer, include

nausea, vomiting, and diarrhea. Malnutrition reduces the potential response of the malignancy to chemoradiotherapy and impairs the patient’s Inhibitors,research,lifescience,medical ability to tolerate the full course of PP242 in vivo treatment (8). In addition, the importance of adequate nutritional status prior to a major operation is well recognized (9). Evidence clearly indicates that malnourished patients who undergo major operations are predisposed to infectious complications and worse postoperative outcomes (9-11). Nutritional deficiencies may also contribute to the trend of amplified perioperative morbidity and mortality Inhibitors,research,lifescience,medical among esophageal cancer patients receiving multimodal therapy compared with patients undergoing Inhibitors,research,lifescience,medical resection alone (12,13). We hypothesized that patients treated with neoadjuvant

therapy and who received removable stents would have better nutrition-related outcomes compared with those who were not stented. The objective of this study was to evaluate of the effectiveness of stents for improving the nutritional status of patients undergoing neoadjuvant therapy for esophageal cancer. Methods Study protocol We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses PRISMA guidelines where possible in performing our systematic review (14). We performed a systematic search through MEDLINE (from 1950), Inhibitors,research,lifescience,medical PubMed (from 1946), EMBASE (from 1949), Current Contents Connect (from 1998), Cochrane library, Google scholar, Science Direct, and Web of Science to May 2013. The search terms included “esophageal cancer”, “neoadjuvant therapy” and “stents”, which second were searched as text word and as exploded medical subject headings where possible. No language restrictions were used in either the search or study selection. The reference lists of relevant articles were also searched for appropriate studies. A search for unpublished literature was not performed. Study selection We included studies that met the following inclusion criteria: • Studies identifying the population of patients with esophageal cancer undergoing stent implantation prior or during neoadjuvant therapy.