McKeown—cervical anastomosis in minimally invasive esophagectomy

Abstract

: Esophagectomy is the preferred treatment in advanced esophageal cancer, but the location of the anastomosis after esophagectomy is debatable. Here, we discuss leakage rates between cervical or intrathoracic anastomosis and complications related to fistulae. The aim of this review article is to describe the McKeown procedure with step-by-step cervical anastomosis. We also update evidence in the literature and discuss the experience of our institution. We report our experience with the cervical anastomosis in minimally invasive esophagectomy and performed a brief review of patients operated in our institution mainly related the rate of cervical fistulas. From 2009 to 2019, more than 345 esophagectomy with cervical anastomosis were performed, and fistula was diagnosed in 46 (13.3%). The spontaneous preferred locations of the liquid drainage after leakage were cervical (38/46, 82.6%), upper mediastinum (4/46, 8.7%), and mediastinum with mediastinitis (4/46, 8.7%). The main risk factors for anastomosis leak are gastric tube perfusion, obesity, heart failure, coronary heart disease, vascular disease, smoking, and cervical anastomosis. The literature shows different opinions and results based on surgeon and center experiences. The McKeown procedure is a feasible, standardized, and secure procedure. Anastomosis leak increases the morbidity and mortality and the frequency of anastomotic leakage in the literature. The rate is around 10% with low mortality.