Abstract
<title>Abstract</title> <p>Objective The objective of this study was to assess perioperative safety and oncological efficacy following minimally invasive McKeown esophagectomy (MIE-McKeown) in a large single-center cohort, providing evidence for the standardized clinical practice of this procedure. Methods 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. Results All procedures were completed successfully without intraoperative death or open conversion, with an R0 resection rate of 98.1%. The cohort exhibited a median operative duration of 240 minutes, median estimated intraoperative hemorrhage of 50 milliliters, median postoperative hospitalization of 11 days and a median 9-day interval prior to initial oral liquid intake.The perioperative mortality was 0.6%, with anastomotic leakage and pulmonary complication rates of 3.6% and 12.6%, respectively. The cohort demonstrated 1-, 3-, and 5-year OS probabilities of 93.9%, 72.3%, and 60.1%, alongside respective DFS probabilities of 82.9%, 64.1%, and 55.5%. Females and early-stage patients had superior survival. Patients who received neoadjuvant chemoimmunotherapy had an equivalent 3-year OS but a superior 3-year DFS than those who received neoadjuvant chemotherapy alone or who did not receive neoadjuvant therapy (P = 0.029). Preoperative underweight reduced OS without affecting DFS, and thoracic duct ligation did not influence long-term survival. Conclusion MIE-McKeown is safe and oncologically effective. Individualized management based on tumor stage, preoperative nutritional status and neoadjuvant regimens helps optimize long-term patient prognosis.</p>