Upper GI

Oesophagectomy (McKeown Three-Stage)

OESOPHAGECTOMY (McKEOWN THREE-STAGE)

Indication: Carcinoma of the mid or proximal oesophagus where wide proximal resection margins and a cervical anastomosis are required. Three incisions used: abdominal, right thoracic, and cervical.

Patient Position: Left lateral (thoracic phase), supine (abdominal and cervical phases).

Anaesthesia: General with double-lumen tube for thoracic phase.

Phase 1 — Right Thoracotomy or VATS:
1. Right thoracic access. Oesophagus mobilised in the posterior mediastinum with thoracic lymphadenectomy. Azygos vein divided. Oesophagus freed to thoracic inlet. Divided just above the carina.

Phase 2 — Abdominal: