Safety and oncological efficacy of minimally invasive McKeown esophagectomy: A 10-year single-center experience of 808 consecutive patients operated by a single surgeon

Imagine the human body as a bustling city, and the esophagus as its main highway, a long, flexible tube that shuttles food from the "dining hall" in the throat down to the "storage warehouse" in the stomach. Sometimes, this highway gets blocked by a nasty, invasive construction crew called cancer. When that happens, the only way to clear the road is to cut out the damaged section and stitch the healthy ends back together. This is a massive operation known as an esophagectomy. For decades, surgeons had to cut wide open the chest and belly to do this, which was like tearing down a whole city block to fix a single pothole—effective, but incredibly traumatic for the patient.

Recently, a new tool arrived: the "minimally invasive" approach. Think of this as using a high-tech, remote-controlled drone and tiny robotic arms instead of a bulldozer. Surgeons make just a few tiny holes, insert cameras and instruments, and perform the surgery from the inside out. One specific version of this, called the McKeown procedure, is like a three-stage relay race: the surgeon clears the highway in the chest, then the belly, and finally the neck, reconnecting the stomach to the throat up high. The big question for doctors and patients is: Is this delicate, high-tech "drone surgery" actually safe, and does it stop the cancer from coming back as well as the old, heavy-handed method? This paper dives into a massive real-world test of exactly that.

The Great Esophageal Rescue Mission

In this study, a single surgeon at Sir Run Run Shaw Hospital in China decided to put the "drone surgery" (Minimally Invasive McKeown esophagectomy, or MIE-McKeown) through its paces. Instead of looking at a tiny group of patients, they gathered data on a whopping 808 people who had this specific surgery between March 2016 and December 2025. That's a huge crowd, making this one of the largest single-surgeon stories ever told about this procedure.

The results were surprisingly smooth. Out of all 808 patients, zero died during the surgery itself, and zero had to be converted to the "old school" open method because things went wrong. The surgeons managed to remove the cancer completely with clean edges (known as an R0 resection) in 98.1% of the cases. It was like a surgical team performing a perfect heist where they got the target and left no trace.

The "drone" approach also meant the patients didn't bleed much. The average blood loss was just 50 milliliters—that's less than a small juice box! The surgery took about 240 minutes (4 hours) on average. Afterward, the patients recovered quickly: they stayed in the hospital for a median of 11 days and were able to start sipping liquids just 9 days after the operation. While there were some bumps in the road—like a 3.6% rate of leaks at the new connection point and a 12.6% rate of lung issues like pneumonia—these numbers are quite low for such a complex operation. Tragically, 5 patients (0.6%) did pass away from complications, mostly due to severe pneumonia or the body being too weak to recover, but for the vast majority, the surgery was a success.

The Long-Term Scoreboard

The real test, however, isn't just surviving the surgery; it's surviving the cancer. The researchers followed these patients to see how long they stayed cancer-free and alive.

• 1 year later: 93.9% of patients were still alive.
• 3 years later: 72.3% were still alive.
• 5 years later: 60.1% were still alive.

These numbers are impressive, especially when you look at who did best. The study found that women had better survival rates than men, and patients who caught the cancer early (Stage I) had an 81.0% chance of being alive in 5 years, compared to just 22.7% for those with Stage IV cancer.

The study also looked at the "pre-game training" patients received. Some had chemotherapy alone, some had nothing, and some had a powerful combo of chemotherapy plus immunotherapy (drugs that wake up the body's immune system to fight cancer). The combo group didn't necessarily live longer in the 3-year mark, but they were much better at staying cancer-free. Their 3-year "disease-free survival" was 67.7%, which was significantly better than the other groups. This suggests that the immunotherapy combo is great at hunting down those tiny, hidden cancer cells that might try to sneak back later.

What Didn't Matter (And What Did)

The researchers also tested some common worries. They wondered if being underweight before surgery would ruin the outcome. It turns out, being underweight didn't change the risk of the cancer coming back, but it did make it harder for patients to survive long-term. It's like trying to run a marathon with an empty gas tank; the car (the body) might not break down immediately, but it won't last the distance.

They also checked if cutting the "thoracic duct" (a tube that carries lymph fluid) during surgery to prevent fluid leaks hurt the patient's long-term survival. The answer? It didn't matter. Whether they cut it or not, the long-term survival rates were the same.

The Bottom Line

This paper tells a hopeful story. It shows that for a single, highly skilled surgeon, the minimally invasive McKeown procedure is not just a fancy trick, but a safe and effective way to treat esophageal cancer. It gets the job done with less blood loss and faster recovery than the old methods, and it keeps patients alive and cancer-free for years. The key to the best results? Catch the cancer early, make sure the patient is well-nourished before the big day, and consider the powerful combo of chemo and immunotherapy for those with advanced tumors. It's a victory for the "drone" approach, proving that sometimes, the smallest tools can fix the biggest problems.