McKeown procedure

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The McKeown procedure ("tri-incisional esophagectomy") is a type of esophagectomy, that is similar in concept to an Ivor Lewis procedure, but it tends to be used for esophageal lesions that are higher in the esophagus.

Procedure

  • laparotomy
    • stomach mobilized, the esophagus
    • "gastric tube" may be formed
    • abdominal lymphadenectomy
    • possible pyloroplasty or pylormyotomy (not practiced by all surgeons)
  • right thoracotomy (fifth intercostal space)
    • esophagus and adjacent tissue removed en bloc
    • mediastinal lymphadenectomy
    • stomach (or gastric tube) pulled into chest and anastomosed with the more proximal esophagus
  • left neck insicion
    • for formation of a cervical anastomosis

Differential diagnosis

The imaging differential diagnosis includes