Esophageal cancer associated with right aortic arch: report of two cases

Management of esophageal cancer in patients with a right aortic arch or double aortic arch: a case series of 34 cases

BACKGROUND

Few cases describing patients with a right aortic arch (RAA) or double aortic arch (DAA) and esophageal cancer (EC) have been reported.

METHODS

We analyzed RAA and DAA cases treated with esophagectomy in our center's database and reported in English-language studies until April 1, 2023. Our study assessed the malformation characteristics and surgical details of EC patients with RAA and DAA.

RESULTS

We extracted data of 24 EC patients with RAAs and 10 EC patients with DAAs. In both groups, the patients were more likely to be Japanese and male, to have squamous cell carcinoma and to have tumors located in the upper thoracic esophagus or middle thoracic esophagus. Left thoracotomy was commonly applied for RAA patients. For DAA patients, the proportions of left-sided and right-sided approaches were similar. Esophagectomy under video-assisted thoracoscopic surgery (VATS) in RAA or DAA patients had been performed on a routine basis in recent years. There were two anastomotic leakages in each group. Specifically, Kommerell diverticulum rupture occurred in 1 RAA patient; gastric tube dilation occurred in 1 DAA patient; and recurrent laryngeal nerve (RLN) injury occurred in 2 RAA patients. The postoperative course was uneventful for most patients in both cohorts.

CONCLUSIONS

Esophageal carcinoma is rarely seen in patients with an RAA or DAA. To adequately dissect superior mediastinal LNs, an auxiliary incision (such as sternotomy), the left door open method or a preceding cervical procedure should be used appropriately. Esophagectomy, whether via thoracotomy or thoracoscopic surgery, can be performed safely for both RAA and DAA.

Pharyngolaryngectomy with thoracoscopic esophagectomy via the left thoracic approach for cervical esophageal cancer with right aortic arch: Case report

We performed pharyngolaryngectomy with thoracoscopic esophagectomy via the left thoracic approach and reconstruction of the elongated gastric conduit with microvascular anastomosis for an 83-year-old male patient with esophageal cancer and right aortic arch. For such cases, a surgical approach via the left thoracic cavity is rational, and cases of pharyngolaryngectomy with thoracoscopic esophagectomy require a long reconstruction organ. Also, in cases of right aortic arch, a longer reconstruction route is made to avoid Kommerell's diverticulum. The patient had laryngeal cancer and was diagnosed with cervical esophageal cancer and preoperative computed tomography revealed right aortic arch. There were no complications after surgery, and food intake was good. Pharyngolaryngectomy with thoracoscopic esophagectomy via the left thoracic approach and reconstruction of the elongated gastric conduit with microvascular anastomosis is suggested to be a safe and feasible technique for cases of cervical esophageal cancer with right aortic arch.

An acquired transposition of the aortic arch secondary to large esophageal cancer misdiagnosed as a right-side aortic arch

The present study is the first reported case of a patient undergoing esophagectomy with ectopic aortic arch secondary to a large esophageal cancer, which was pre-operatively misdiagnosed with a right-side aortic arch (RAA). The patient, a 54-year-old male, was first admitted to our hospital for esophagectomy owing to esophageal squamous cancer and had complained of progressive dysphasia for 3 months. Chest computed tomography (CT) revealed a mass in the middle thoracic esophagus. Furthermore, the three-dimensional CT of the thoracic great arteries showed a possible RAA and a curved descending aorta. After preoperative evaluation, the approach of using a left thoracotomy with cervical anastomosis was successfully performed and favorable short-term outcomes were achieved. According to previous reports, and the experience of the presented case, we emphasize clear recognition of the anatomical situation in the upper mediastinum and the importance of an optimal surgical approach for esophagectomy.

Esophageal cancer associated with right aortic arch and thyroid adenoma

A 55-year-old Chinese woman with thoracic esophageal cancer associated with right aortic arch and thyroid adenoma was admitted to our hospital. Computed tomography revealed a right aortic arch with mirror-image branching and a mass in the esophagus. The following barium-coated esophagograms and esophagoscopy showed an ulcerative and infiltrative tumor in the upper thoracic esophagus. The patient also had an almost 10-year history of thyroid adenoma.

Thymoma concomitant with a right aortic arch

A 63-year-old woman was referred to our hospital because screening had detected an anterior mediastinal tumor with a right aortic arch. She underwent typical total thymectomy via a median sternotomy but developed left recurrent laryngeal nerve (RLN) palsy postoperatively. The pathology examination revealed that the tumor was a stage I thymoma. This is the first report of a thymoma with a right aortic arch. The left RLN goes around the left ductus arteriosus, which connects the origin of the left subclavian artery to the left pulmonary artery. The RLN was likely to be injured in the neighborhood of the left ductus arteriosus when the tumor and thymus were dissected over the pulmonary artery. During operations for an anterior mediastinal tumor with a right aortic arch, we should be attentive to the location of the tumor, the left ductus arteriosus, and the left RLN.

Esophageal cancer associated with right aortic arch: report of two cases

Esophageal carcinoma associated with a right aortic arch is very rare. In such cases, the dissection of right paratracheal lymph nodes is difficult. Herein, we report two cases of thoracic esophageal carcinoma with right aortic arch, for which the left door open method was used to provide a good surgical view. Postoperative chemotherapy and radiotherapy were used for both cases and no evidence of recurrence or metastasis has been noted in the 24-month postoperative period.