Does the SANO trial really move us toward organ preservation for esophageal cancer?

Does the SANO trial really move us toward organ preservation for esophageal cancer?The SANO t rial 1 was a multicenter, stepped-wedge, cluster-randomised non-inferiority, phase 3 trial that sought to compare active surveillance versus standard surgery in patients with locally advanced esophageal cancer and a clinical complete response after neoadjuvant chemoradiotherapy.The study was powered for non-inferiority in overall survival at 2 years with a non-inferiority margin of 15%.Of 1115 patients screened, 274 were randomized with 35 added from the pre-SANO trial, totaling 309 patients selected, 198 and 111 in active surveillance and surgery groups, respectively.At 2 years follow-up, the study suggests that active surveillance was non-inferior to surgery after a modified intention-to-treat analysis.Despite the obvious interest in an organ preservation strategy for esophageal cancer, there are important limitations of this study, which must be carefully considered in the interpretation of the findings.