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Ivor Lewis and McKeown: what the names mean | CION Cancer Clinics
Ivor Lewis and McKeown are the two common ways of removing the food pipe through the chest. The difference is where the new join is made. Ivor Lewis works through the abdomen and the right chest and joins the stomach tube inside the chest. McKeown adds a small cut in the neck and makes the join there. This page explains what each involves, why one is chosen over the other, and what the names cannot tell you. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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On this page
- What is the difference between Ivor Lewis and McKeown?
- What does each operation actually involve?
- How do the two compare, point by point?
- Which words will you see in the surgeon's letter?
- Four things families ask, and what is actually true
- What can this page not tell you?
- Common questions about Ivor Lewis and McKeown
The short answer
What is the difference between Ivor Lewis and McKeown?
Both are operations that remove the food pipe through the chest. The difference is where the new join is made. In an Ivor Lewis operation the surgeon works in the abdomen and the right side of the chest, and joins the stomach tube to the food pipe inside the chest. In a McKeown operation the surgeon adds a third cut in the neck and makes the join there.
Why the names
They are the names of the surgeons who first described each version. The names have stuck, so they appear on consent forms even though they tell you nothing unless you already know. Your surgeon may also call them "two-stage" and "three-stage", counting the parts of the body that are opened.
Why the join position matters
A join in the chest sits deep, close to the heart and lungs. If it leaks, the leak is inside the chest and needs prompt treatment. A join in the neck is nearer the surface, so a leak there usually drains through the neck wound and is easier to manage, but neck joins leak and narrow more often and the nerve to the voice box is at risk.
Who each does not suit
Ivor Lewis is not used for tumours high in the chest, because there would not be enough healthy food pipe above the tumour to join to. McKeown is usually avoided when the neck stage adds risk without benefit, such as a low tumour in a person whose voice or swallowing is already weak.
Two named operations
What does each operation actually involve?
Ivor Lewis, two stages
The surgeon starts in the abdomen, frees the stomach and clears the nodes there. You are then turned on your left side and the right chest is entered. The food pipe and the chest nodes come out, the stomach tube is brought up, and the join is made high in the chest.
Usually chosen for
- Tumours in the lower third of the food pipe
- Tumours at the junction with the stomach
McKeown, three stages
The chest is usually done first, freeing the food pipe and clearing the nodes. Then the abdomen, to prepare the stomach tube. Then a cut on the left side of the neck, where the tube is pulled up and joined to the short piece of food pipe that remains.
Usually chosen for
- Tumours in the middle or upper chest
- Where a longer length must be removed
Either one, open or keyhole
Both can be done through long cuts or through small keyhole ports with a camera, or a mixture. Keyhole changes the size of the cuts, not the sequence or the place of the join. Ask which is planned for you, and why.
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Ask an oncologistSide by side
How do the two compare, point by point?
Ivor Lewis
McKeown
Cuts in the abdomen and the right chest
Cuts in the abdomen, the right chest and the neck
Join inside the chest
Join in the neck
A leak is less common but harder to treat
A leak is more common but usually easier to manage
Hoarse voice is uncommon
Hoarse voice is more common, usually temporary
Less food pipe removed
Almost the whole food pipe removed
No neck scar
A small scar on the left side of the neck
Did you know
The join in a McKeown operation is made in the neck, but the work of removing the food pipe still happens in the chest. So a McKeown is not a "no chest" operation. The route that avoids the chest altogether is called transhiatal, and it has its own page in this section.
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On your paperwork
Which words will you see in the surgeon's letter?
- Two-stage or three-stage
- Another way of saying Ivor Lewis or McKeown. The number counts the areas opened: abdomen and chest, or abdomen, chest and neck.
- Intrathoracic anastomosis
- A join made inside the chest. This is the Ivor Lewis join.
- Cervical anastomosis
- A join made in the neck. This is the McKeown join. "Cervical" here means the neck, not the cervix.
- Right thoracotomy
- A cut between the ribs on the right side of the chest. Most of the food pipe is easier to reach from the right, away from the heart.
- Proximal margin
- The length of healthy food pipe removed above the tumour. A higher tumour needs the join higher up, which is what pushes the surgeon towards the neck.
Commonly believed
Four things families ask, and what is actually true
"Three stages must be worse than two."
The third stage is a small neck cut, not a whole extra operation. The chest and abdominal work is the same in both. Recovery time, ICU stay and the eating rules afterwards are much the same; what differs is the pattern of possible complications.
"A neck join means the cancer was higher and worse."
A neck join means the tumour sat higher, or the surgeon wanted a longer margin. Position is not the same as stage. A small early tumour in the middle of the chest may need a McKeown; a larger low tumour may be an Ivor Lewis.
"If the voice goes hoarse, the operation went wrong."
A hoarse voice after a neck join usually means the nerve to the voice box was bruised while the surgeon worked beside it. It is a known effect, not a mistake, and it usually improves over weeks. A speech therapist can help while it recovers.
"We can pick the one we prefer."
The choice follows the tumour's position, the length of food pipe that must go, and the surgeon's experience. You can ask why one has been chosen, and you can seek a second opinion, but it is not a preference to be selected from a list.
Being straight with you
What can this page not tell you?
This page cannot tell you which of the two you should have. That depends on the exact height of the tumour on your endoscopy report, on what the PET-CT shows about the nodes, on your fitness tests, and on which operation your surgeon does most. It cannot tell you how your operation will turn out, either.
The operation name carries no outlook
Hearing "Ivor Lewis" or "McKeown" tells you where the join will be. It tells you nothing about the stage of the cancer or about what happens afterwards. Those questions are answered by the pathology report that comes after the operation, and by how you recover, and no one can read them off the operation's name.
What to ask at the next appointment
Ask how far from the teeth the tumour was measured at endoscopy, because that number is what places it in the chest. Ask where the join will be and why. Ask whether the operation will be open or keyhole. Ask how many of these the surgeon and the centre do each year. Ask what the plan is if the join leaks, and who to call once you are home.
If the letter names an operation this page has not covered, send it to the helpline and someone will read it with you.Questions we are asked
Common questions about Ivor Lewis and McKeown
Is one safer than the other?
Neither is safer across the board. Each has its own pattern of complications: chest-join leaks are rarer but more serious, neck-join leaks are commoner but easier to manage, and neck joins carry more risk to the voice. What lowers risk most is a centre and surgeon who do the operation often.
Why is the chest opened on the right side?
Because the heart sits to the left and the food pipe runs down the right side of the chest for most of its length. Entering from the right gives the surgeon a clear view of the food pipe and the nodes without working around the heart.
Will there be a scar on the neck?
Only with a McKeown. The neck cut is small, on the left side, and fades over months. An Ivor Lewis leaves scars on the abdomen and the right chest only. Keyhole versions leave small marks instead of long cuts.
Does the McKeown remove more of the food pipe?
Yes. Because the join is made in the neck, almost the whole food pipe comes out, which gives a longer margin above the tumour. That is the main reason it is chosen for tumours in the middle or upper chest, where an Ivor Lewis join would sit too close to the tumour.
Will her voice come back if it goes hoarse?
Usually, yes. Most hoarseness after a neck join is from bruising of the nerve, and the voice improves over weeks to months. A small number have longer-lasting weakness, and a speech therapist can help with both the voice and safe swallowing. Report any choking on liquids.
Can it be done by keyhole?
Both can be, in full or in part. The abdominal stage is very often done by keyhole; the chest stage may be keyhole or open. Ask your surgeon which parts will be keyhole and why. The minimally invasive page in this section explains what keyhole changes.
Is the recovery different?
Broadly no. Both need intensive care at first, a period without eating while the join heals, a feeding tube, and the same slow return to small meals. The neck wound adds a little care after a McKeown. Hospital stay depends on how the join and the lungs behave, not on which operation was done.
Are both covered by Aarogyasri and insurance?
They are covered under the same heading, as an esophagectomy. Aarogyasri, CGHS, ECHS and EHS are accepted at CION and most cashless insurers are empanelled. Costs are indicative and change more with length of stay than with the operation's name. Call the helpline with your card details to check your cover.
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Sources
- Cancer Research UK — Surgery for oesophageal cancer
- American Cancer Society — Surgery for esophageal cancer
- National Cancer Institute — Esophageal cancer treatment (PDQ), patient version
- Macmillan Cancer Support — Oesophageal cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Transhiatal vs transthoracic esophagectomyThe route that avoids the chest, compared with these twoMinimally invasive esophagectomyWhat keyhole changes for either operationAnastomotic leak after esophagectomyWhy the position of the join mattersHoarse voice after esophagectomyMore common after the McKeown neck joinEsophagectomy: what the operation involvesThe whole operation, from ward to ICU
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