Our approach to MIE has been refined over the study time period and both techniques have been described in detail elsewhere.5 (link),7 (link) Briefly, we defined modifications of the McKeown approach as MIE-neck, consisting of either (1) laparoscopic esophagectomy with gastric-pull through and cervical anastomosis (n = 19) or (2) thoracoscopic esophageal mobilization and intrathoracic lymphadenectomy followed by laparoscopic gastric mobilization and formation of the gastric conduit (Fig. 1), lymph node dissection, and cervical anastomosis. In most cases, a staging laparoscopy was performed in the same setting or as a separate procedure to ensure resectability. We defined modifications of the Ivor Lewis technique as MIE-chest, consisting of laparoscopic gastric mobilization and formation of a gastric conduit (Fig. 1) and lymph node dissection, followed by thoracoscopic esophageal mobilization and intrathoracic lymphadenectomy. An intrathoracic anastomosis was performed thoracoscopically through a non–rib-spreading, mini–access incision (4 to 5 cm), typically using an end-to-end anastomotic (EEA) stapler (Fig. 2). Most of the patients also had placement of a feeding jejunostomy tube (>95%) and a pyloric drainage procedure (>85%).