Abstract / Summary
To describe perioperative outcomes and long-term survival after minimally invasive McKeown esophagectomy (MIE-McKeown) in a large single-center cohort and to explore unadjusted associations between selected clinical characteristics and survival. Cumulatively, 808 patients with esophageal cancer who underwent MIE-McKeown performed by a single surgeon at our hospital from March 2016 to December 2025 were enrolled. Collected perioperative indicators and follow-up data were analyzed to determine overall survival (OS) and disease-free survival (DFS) using the Kaplan–Meier approach, while log-rank testing was performed to identify intergroup survival disparities. Among 808 patients, no intraoperative death or unplanned conversion to open surgery was recorded, and 793 (98.1%) achieved R0 resection. Median operative duration was 240 min, median estimated blood loss was 50 mL, median postoperative hospitalization was 11 days, and median time to first oral liquid intake was 9 days. In-hospital mortality was 0.6%; anastomotic leakage and pneumonia occurred in 3.6% and 12.6%, respectively. The 1-, 3-, and 5-year OS estimates were 93.9%, 72.3%, and 60.1%, and the corresponding DFS estimates were 82.9%, 64.1%, and 55.5%. In unadjusted exploratory analyses, survival distributions differed across sex, pathological stage, neoadjuvant-treatment and BMI groups. The global DFS comparison among the three main neoadjuvant groups was statistically significant ( P = 0.029); this observational comparison does not establish treatment superiority. Lower OS was observed in the BMI ≤ 18.5 kg/m² group, whereas DFS did not differ significantly across BMI groups. OS and DFS did not differ significantly by thoracic-duct ligation status in unadjusted analyses. This 10-year single-center cohort provides descriptive perioperative and long-term survival estimates after MIE-McKeown. Associations observed in unadjusted subgroup analyses should be interpreted as exploratory and non-causal.