McKeown esophagectomy for esophageal cancer: comparison of robotic, thoraco- / laparoscopic, and open surgery; optimization of reconstruction route, anastomosis, and extent of lymphadenectomy (narrative review)
Dobrzhanskyi O.1,2, Kondratskyi Y.1, Nastashenko I.1,2, Pepenin I.1,2, Kolesnyk A.1, Turchak V.1, Horodetskyi A.1,2, Koval N.1, Svichkar Y.1,2, Ukrainets I.1, Shudrak Y.1,2
- 1Nonprofit Organization National Cancer Institute, Kyiv, Ukraine
- 2Bogomolets National Medical University, Kyiv, Ukraine
Summary. This narrative review addresses McKeown (three‑incision) esophagectomy for esophageal and esophagogastric junction cancer. The aim was to compare robotic‑assisted, thoraco‑ / laparoscopic minimally invasive, and open approaches in terms of perioperative morbidity, oncologic adequacy, and functional outcomes, and to summarize evidence on reconstruction route, cervical anastomotic technique, and lymphadenectomy extent. Across contemporary studies, minimally invasive platforms (Conventional Minimally Invasive Esophagectomy and Robot-Assisted Minimally Invasive Esophagectomy (MIE and RAMIE)) in experienced centers are generally associated with lower blood loss, shorter ICU / hospital stay, and fewer severe pulmonary complications compared with open surgery, while maintaining key oncologic metrics (R0 resection and lymph‑node yield). However, the cervical anastomosis intrinsic to the McKeown configuration drives a specific risk profile, including recurrent laryngeal nerve injury and anastomotic stricture, highlighting the need for strict indications and individualized approach selection. Reconstruction route and objective perfusion assessment (e.g., indocyanine green fluorescence) may affect leak risk, and the choice between two‑field and three‑field lymphadenectomy should be tailored to tumor location, histology, and neoadjuvant therapy.
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