General Surgery · Upper GI

McKeown Tri-Incisional Oesophagectomy

OPERATION: McKeown Tri-Incisional Oesophagectomy (Right Thoracotomy, Laparotomy, Left Cervical Anastomosis)
ANAESTHETIC: General anaesthesia — double-lumen endotracheal tube for one-lung ventilation. Thoracic epidural placed pre-operatively.
ANTIBIOTICS: IV antibiotics at induction. VTE prophylaxis — subcutaneous heparin and sequential compression devices from induction.
POSITION: Three sequential positions — left lateral decubitus (thoracic phase), supine (abdominal phase), supine with neck extended (cervical phase).

INDICATION:
Carcinoma of the mid or upper oesophagus — tumour at or above the level of the carina, requiring complete oesophageal removal with cervical anastomosis. [Preoperative staging: EUS, CT chest/abdomen/pelvis, PET-CT. Bronchoscopy performed to confirm airway integrity for mid and upper oesophageal tumours]. Neoadjuvant chemoradiotherapy completed [date]. Nutritional status assessed — jejunostomy feeding planned.

PHASE 1 — RIGHT THORACOTOMY:
Patient placed in left lateral decubitus with approximately 30-degree forward tilt. Abbreviated right posterolateral thoracotomy — incision from beneath the tip of the scapula extending posteriorly approximately 10 cm. Latissimus dorsi divided; serratus anterior muscle spared and retracted anteriorly. Chest entered through the fifth interspace above the sixth rib. 2 cm of posterior sixth rib removed to facilitate retraction. Lung retracted anteriorly; inferior pulmonary ligament divided.

OESOPHAGEAL MOBILISATION: