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VATS-assisted McKeown Esophagectomy

Three-stage minimally invasive esophagectomy with cervical anastomosis.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Genel Cerrahi department. Book Appointment →

What is VATS-assisted McKeown Esophagectomy?

Video-assisted thoracoscopic surgery (VATS) McKeown esophagectomy is a three-stage minimally invasive operation for esophageal cancer that combines a right thoracoscopic mobilization of the esophagus, an abdominal phase to create a gastric conduit, and a cervical anastomosis in the left neck. It is the preferred approach for upper- and mid-thoracic tumors where extensive lymphadenectomy and a high anastomosis are required.

Compared with open Ivor-Lewis or transhiatal techniques, VATS McKeown reduces postoperative pulmonary complications, blood loss, and hospital stay while maintaining equivalent oncologic outcomes including R0 resection rates and lymph node yield. Robotic adaptation (RAMIE-McKeown) further enhances visualization and dexterity for upper mediastinal lymphadenectomy along the recurrent laryngeal nerves.

Patient selection includes preoperative staging with PET-CT and endoscopic ultrasound, neoadjuvant chemoradiotherapy when indicated, and assessment of cardiopulmonary reserve. Common complications are anastomotic leak (5-15 percent), recurrent laryngeal nerve injury, chylothorax, and gastric conduit ischemia. ERAS protocols and centralization to high-volume centers improve outcomes.

Symptoms

Progressive solid-food dysphagia
Significant unintentional weight loss
Retrosternal pain or odynophagia
Regurgitation and aspiration
Hematemesis or melena
Hoarseness from recurrent laryngeal involvement
New-onset cough during meals

Risk Factors

Smoking and chronic alcohol use
Long-segment Barrett esophagus
Gastroesophageal reflux disease
Achalasia and chronic strictures
Caustic injury history
HPV-related squamous tumors
Family history of esophageal cancer

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Solid food dysphagia lasting more than two weeks
  • Unintentional weight loss above 5 percent
  • Recurrent vomiting or regurgitation
  • Hematemesis or anemia of unclear cause
  • Suspicious endoscopy or CT finding

Treatment Methods

01
Preoperative staging with PET-CT and EUS
02
Neoadjuvant chemoradiotherapy when indicated
03
Right VATS thoracoscopic esophageal mobilization
04
Laparoscopic or open gastric conduit creation
05
Cervical esophagogastric anastomosis
06
Two- or three-field lymphadenectomy
07
ERAS recovery protocol and high-volume center care

Which Department to Visit?

You can visit our Genel Cerrahi department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.