Surgery for Esophageal Adenocarcinoma: Three field open McKeown procedure has a role in assessment and treatment of extensive locally advanced esophageal adenocarcinoma with a favorable clinical and pathological outcome.

Esophageal adenocarcinoma has seen increased incidence due to gastroesophageal reflux disease, smoking, and obesity. There are no established guidelines for screening of esophageal cancer and many patients present late in their disease process. Most early stage adenocarcinoma of the esophagus is treated with neoadjuvant chemotherapy and radiation, followed by surgical resection. We describe a case of locally advanced esophageal cancer where the patient had a relatively insignificant response to neoadjuvant chemotherapy and radiation, who was then treated by open direct resection of the esophagus and proximal stomach (three field McKeown approach) with lymphadenectomy. There were no surgical complications such as anstomotic leak or chylothorax. Pathology showed T2N0 disease. The mainstay of esophageal resection continues to be minimally invasive procedures for early stage esophageal malignancy; however, locally advanced esophageal cancer in the mediastinum occasionally requires an open direct approach. We felt that this was a necessary procedure due to the large mass effect of the tumor, and a preoperative staging of T2N3. In this case, despite recent advancements, there was a limited response of the cancer to neoinduction therapy. Surgery was necessary to both assess and treat this cancer, proving that older, established therapy is still relevant.