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McKeown, or three-hole, esophagectomy is the preferred surgical technique for resection of midesophageal malignancies. It allows for a three-field lymph node dissection with a cervical neck anastomosis. However, because of the significant morbidity that can result from the extensive nature of this operation, minimally invasive techniques have evolved to mitigate some of these effects. In North America, there has been a shift in the epidemiology of esophageal malignancy from the previously predominant midesophageal squamous cell carcinoma to the more distal esophageal adenocarcinoma. Ivor Lewis esophagectomy with intrathoracic anastomosis is often preferred for distal esophageal malignancies, whereby neck dissection and related complications such as recurrent laryngeal nerve injury may be avoided. In the contemporary era of esophageal surgery, however, surgeons are able to select the appropriate operation or approach on the basis of the extent of disease, and McKeown esophagectomy remains an important and necessary technique in a surgeon’s armamentarium. This review will outline the evolution of minimally invasive three-hole esophagectomy and evaluate the operative and oncologic outcomes of this procedure.

Minimally invasive McKeown esophagectomy: a narrative review of current operative and oncologic outcomes