ORIGINAL RESEARCH article
Front. Oncol.
Sec. Gastrointestinal Cancers: Gastric and Esophageal Cancers
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1644505
Comparative Evaluation of Transmediastinal and Minimally Invasive McKeown Esophagectomy for Esophageal Cancer: Perioperative and Oncologic Outcomes
Provisionally accepted
- 1Nanhua Hospital Affiliated to Nanhua University, Hengyang, China
- 2Xupu County Traditional Chinese Medicine Hospital, Huaihua, China
- 3Changsha Fourth Hospital, Changsha, China
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Background: Esophageal squamous cell carcinoma remains a major health burden in China, where surgical resection is the mainstay of curative therapy. The conventional minimally invasive McKeown esophagectomy (MIE-McKeown), although oncologically effective, entails transthoracic access and single-lung ventilation, often resulting in higher postoperative morbidity. Thoraco-laparoscopic transmediastinal esophagectomy has emerged as a novel alternative that may mitigate these risks while preserving oncologic integrity. Methods: A retrospective cohort study was conducted involving 268 patients with resectable middle or lower thoracic esophageal squamous cell carcinoma (clinical stage I-III), including 131 who underwent transmediastinal esophagectomy and 137 who received MIE-McKeown. Outcomes assessed included operative time, intraoperative blood loss, lymph node yield, complication profiles, recovery indicators, quality of life (EORTC QLQ-C30), and 6-month disease-free survival (DFS). Statistical comparisons were performed using t-tests, χ² tests, and multivariate logistic regression.The transmediastinal esophagectomy group exhibited significantly shorter operative time (197.2 ± 25.9 vs. 286.5 ± 32.1 min, P<0.001) and reduced blood loss (155.4 ± 40.2 vs. 260.7 ± 65.1 mL, P<0.001). Time to oral intake (4.6 ± 1.1 vs. 6.2 ± 1.3 days, P<0.001), drainage duration (3.8 ± 0.5 vs. 4.4 ± 0.7 days, P<0.001), and hospital stay (9.3 ± 1.8 vs. 11.1 ± 2.2 days, P<0.001) were all significantly improved in the transmediastinal esophagectomy group. The incidence of Clavien-Dindo grade ≥III complications was lower (7.6% vs. 16.0%, P=0.043), particularly pneumonia (7.6% vs. 18.2%, P=0.009) and recurrent laryngeal nerve injury (4.6% vs. 11.7%, P=0.031). Lymph node harvest was comparable (21.4 ± 6.2 vs. 22.1 ± 5.9, P=0.344). Three-month quality-of-life scores were higher in the transmediastinal esophagectomy group for global health (73.4 ± 12.1 vs. 66.5 ± 13.4, P=0.005), physical functioning (78.2 ± 11.8 vs. 70.6 ± 13.6, P=0.008), and role functioning (72.1 ± 14.2 vs. 64.3 ± 15.1, P=0.011). The 6-month DFS rates were similar between groups (93.1% vs. 91.2%, log-rank P=0.327).Conclusions: Thoraco-laparoscopic transmediastinal esophagectomy is a safe, effective, and minimally invasive alternative to the McKeown approach in selected esophageal squamous cell carcinoma patients. It provides superior perioperative outcomes and enhanced recovery without compromising short-term oncologic efficacy.
Keywords: esophageal cancer, transmediastinal esophagectomy, McKeown procedure, minimally invasive surgery, surgical outcomes, Postoperative Complications
Received: 10 Jun 2025; Accepted: 29 Jul 2025.
Copyright: © 2025 Ni, Zhu, Shi, Xia, Liu, Cui, Zhang and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Yi Zhang, Nanhua Hospital Affiliated to Nanhua University, Hengyang, China
Jainxin Zhang, Changsha Fourth Hospital, Changsha, China
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