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 pyloro-myotomy (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 incision
- for formation of a cervical anastomosis
Differential diagnosis
The imaging differential diagnosis includes