In oesophageal squamous cell carcinoma, which surgical approach (Ivor Lewis vs. McKeown vs. transhiatal) is considered to provide optimal oncological lymphadenectomy for mid-thoracic tumours?

• A Transhiatal oesophagectomy (THE) as it avoids thoracotomy and reduces pulmonary complications
• B Ivor Lewis oesophagectomy (right thoracotomy + laparotomy) providing adequate 2-field lymphadenectomy for lower/mid-thoracic tumours
• C Minimally invasive oesophagectomy (MIO) only, as all open approaches carry equivalent lymph node yields
• D McKeown (3-stage) oesophagectomy with cervical anastomosis, enabling 3-field lymphadenectomy for mid-thoracic tumours with upper mediastinal or cervical node involvement ✓

Explanation

For mid-thoracic oesophageal squamous cell carcinoma, the McKeown (three-stage: right thoracotomy, laparotomy, left cervical incision) oesophagectomy enables 3-field lymphadenectomy — thoracic, abdominal, and cervical nodal clearance — which is important for SCC given its propensity for skip metastases to cervical nodes. This approach is particularly favoured in Japan and for upper/mid-thoracic SCC. Ivor Lewis (2-field) provides adequate mediastinal lymphadenectomy for lower third tumours. Transhiatal provides limited mediastinal node sampling and is reserved for high-risk patients. The PORT trial provided data on adjuvant chemoradiotherapy in this setting.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.