Background: The role of neoadjuvant chemotherapy (NAC) or chemoradiotherapy (NACR) in patients with oesophageal carcinoma continues to be debated. This study aimed to assess the comparative efficacy and safety of NAC or NACR for oesophageal carcinoma. Methods: Randomized clinical trials reporting on NAC or NACR with local operable oesophageal carcinoma were identified. The primary endpoint was overall survival (OS). All trial results were combined and analysised using a fixed or random-effects meta-analysis. Quality of evidence was appraised with GRADE criteria. The PROSPERO registry number is CRD42017072242. Results: 40 trials with 8,393 patients were included. High-quality evidence indicated that NAC was associated with a significant benefit on OS (hazard ratio [HR] 0.86, 95% CI 0.80 to 0.92; P = 0.000) and relapse-free survival (RFS) (HR 0.78, 95% CI 0.72 to 0.84; P = 0.000) versus surgery alone, with an absolute difference at 5 years of 10% (6 to 13), and the treatment effect on survival was especially in favor of adenocarcinoma (HR 0.81, 0.72 to 0.91), but no significant difference in squamous-cell carcinoma (SCC) (HR 0.93, 0.81 to 1.08). High-quality evidence revealed that treatment with NACR, as compared with surgery alone, prolonged OS (HR 0.74, 95% CI 0.67 to 0.81; P = 0.000) and RFS (HR 0.74, 95% CI 0.65 to 0.84; P = 0.000), corresponding to an absolute difference at 5 years of 14% (9 to 20), with similar survival for different histological types of tumor: 0.73 (0.65 to 0.83) for SCC and 0.73 (0.62 to 0.93) for adenocarcinoma. There was moderate-quality evidence that the overall direct and indirect comparison of NACR with NAC showed a survival advantage (HR 0.83, 95% CI 0.73 to 0.94; P = 0.004), with results for SCC (HR 0.74, 0.63 to 0.89) and for adenocarcinoma (HR 0.89, 0.74 to 1.10). Conclusions: This study confirmed that a significant clinical benefit is evident for NACR in both adenocarcinomas and SCC of the esophagus, and NAC in patients with adenocarcinoma of the oesophagus. To our knowledge, this is the first evidence-based finding which provided advantage of NACR over NAC in patients with oesophageal carcinoma.