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Evidence found and GRADE certainty

170 questions · 183 findings · 10 reviews · Gut

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No studies found 1 · 0.5%GRADE not reported 3 · 1.6%Very low 50 · 27.3%Low 37 · 20.2%Moderate 60 · 32.8%High 32 · 17.5%

Perioperative chemotherapy vs primary surgery

Overall survival among all patients · resectable adenocarcinoma of the stomach, gastroesophageal junction, and lower esophagus

Perioperative chemotherapy leads to lower overall survival among all patients compared with primary surgery (high certainty).

1 finding from 1 review

Perioperative chemotherapy vs primary surgery

Presence of tumor‐free resection margin · resectable adenocarcinoma of the stomach, gastroesophageal junction, and lower esophagus

Perioperative chemotherapy showed no clear difference in presence of tumor‐free resection margin compared with primary surgery (moderate certainty).

1 finding from 1 review

Perioperative chemotherapy vs primary surgery

Tumor stage at resection (T0 to T2 vs T3 to T4) · resectable adenocarcinoma of the stomach, gastroesophageal junction, and lower esophagus

Perioperative chemotherapy probably leads to higher tumor stage at resection (T0 to T2 vs T3 to T4) compared with primary surgery (moderate certainty).

1 finding from 1 review

Perioperative chemotherapy vs primary surgery

Tumor stage at resection (N0 vs N+) · resectable adenocarcinoma of the stomach, gastroesophageal junction, and lower esophagus

Perioperative chemotherapy may leads to higher tumor stage at resection (N0 vs N+) compared with primary surgery (low certainty).

1 finding from 1 review

Perioperative chemotherapy vs primary surgery

Disease-free survival · resectable adenocarcinoma of the stomach, gastroesophageal junction, and lower esophagus

Perioperative chemotherapy showed no clear difference in disease‐free survival (landmark time 6 months) compared with primary surgery (high certainty).

1 finding from 1 review

Perioperative chemotherapy vs primary surgery

Overall survival by type of data ‐ Individual patient data · resectable adenocarcinoma of the stomach, gastroesophageal junction, and lower esophagus

Perioperative chemotherapy leads to lower overall survival by type of data ‐ Individual patient data compared with primary surgery (high certainty).

1 finding from 1 review

Perioperative chemotherapy vs primary surgery

Overall survival by type of data ‐ Aggregated data · resectable adenocarcinoma of the stomach, gastroesophageal junction, and lower esophagus

Perioperative chemotherapy probably leads to lower overall survival by type of data ‐ Aggregated data compared with primary surgery (moderate certainty).

1 finding from 1 review

Perioperative chemotherapy vs primary surgery

Overall survival by tumor site ‐ Esophagus · resectable adenocarcinoma of the stomach, gastroesophageal junction, and lower esophagus

Perioperative chemotherapy showed no clear difference in overall survival by tumor site ‐ Esophagus compared with primary surgery (high certainty).

1 finding from 1 review

Perioperative chemotherapy vs primary surgery

Overall survival by tumor site ‐ GE junction · resectable adenocarcinoma of the stomach, gastroesophageal junction, and lower esophagus

Perioperative chemotherapy leads to lower overall survival by tumor site ‐ GE junction compared with primary surgery (high certainty).

1 finding from 1 review

Perioperative chemotherapy vs primary surgery

Overall survival by tumor site ‐ Stomach · resectable adenocarcinoma of the stomach, gastroesophageal junction, and lower esophagus

Perioperative chemotherapy showed no clear difference in overall survival by tumor site ‐ Stomach compared with primary surgery (high certainty).

1 finding from 1 review

Perioperative chemotherapy vs primary surgery

Overall survival by chemo‐/radiotherapy ‐ Chemoradiotherapy · resectable adenocarcinoma of the stomach, gastroesophageal junction, and lower esophagus

Perioperative chemotherapy probably leads to lower overall survival by chemo‐/radiotherapy ‐ Chemoradiotherapy compared with primary surgery (moderate certainty).

1 finding from 1 review

Summary of findings table (subcomparison 3): chemotherapy agent(s) plus control intervention vs control intervention

Overall survival · palliative participants with esophageal and GE‐junction carcinoma

Summary of findings table (subcomparison 3): chemotherapy agent(s)… probably leads to lower overall survival compared with control intervention alone (moderate certainty).

1 finding from 1 review

Summary of findings table (subcomparison 3): chemotherapy agent(s) plus control intervention vs control intervention

Toxicity · palliative participants with esophageal and GE‐junction carcinoma

It is very uncertain whether summary of findings table (subcomparison 3): chemotherapy agent(s)… changes toxicity compared with control intervention alone (very low certainty).

1 finding from 1 review

Summary of findings table (subcomparison 5): chemotherapy or targeted therapy agent(s) plus control intervention vs control intervention

Overall survival · palliative participants with esophageal and GE‐junction carcinoma

Summary of findings table: chemotherapy or targeted therapy agent(s)… leads to lower overall survival compared with control intervention alone (high certainty).

1 finding from 1 review

Summary of findings table (subcomparison 5): chemotherapy or targeted therapy agent(s) plus control intervention vs control intervention

Progression‐free survival · palliative participants with esophageal and GE‐junction carcinoma

Summary of findings table: chemotherapy or targeted therapy agent(s)… probably leads to lower progression‐free survival compared with control intervention alone (moderate certainty).

1 finding from 1 review

Summary of findings table (subcomparison 5): chemotherapy or targeted therapy agent(s) plus control intervention vs control intervention

Toxicity · palliative participants with esophageal and GE‐junction carcinoma

It is very uncertain whether summary of findings table: chemotherapy or targeted therapy agent(s)… changes toxicity compared with control intervention alone (very low certainty).

1 finding from 1 review