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Zhang G, Wang Z, Jiao J, Liu Y, Pan D, Yang H, Zhan M, Yan F, Li H, Zhang Y, Li J, Li X. Management of esophageal cancer in patients with a right aortic arch or double aortic arch: a case series of 34 cases. Surg Endosc 2024; 38:240-252. [PMID: 37978082 DOI: 10.1007/s00464-023-10543-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 10/12/2023] [Indexed: 11/19/2023]
Abstract
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.
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Affiliation(s)
- Guoqing Zhang
- Department of Thoracic Surgery and Lung Transplantation, First Affiliated Hospital of Zhengzhou University, No. 1 Jian She Road, Zhengzhou, 450052, Henan, China
| | - Zhulin Wang
- Department of Thoracic Surgery and Lung Transplantation, First Affiliated Hospital of Zhengzhou University, No. 1 Jian She Road, Zhengzhou, 450052, Henan, China
| | - Jia Jiao
- Department of Thoracic Surgery and Lung Transplantation, First Affiliated Hospital of Zhengzhou University, No. 1 Jian She Road, Zhengzhou, 450052, Henan, China
| | - Yipiao Liu
- Department of Thoracic Surgery and Lung Transplantation, First Affiliated Hospital of Zhengzhou University, No. 1 Jian She Road, Zhengzhou, 450052, Henan, China
| | - Dabo Pan
- Department of Thoracic Surgery and Lung Transplantation, First Affiliated Hospital of Zhengzhou University, No. 1 Jian She Road, Zhengzhou, 450052, Henan, China
| | - Hang Yang
- Department of Thoracic Surgery and Lung Transplantation, First Affiliated Hospital of Zhengzhou University, No. 1 Jian She Road, Zhengzhou, 450052, Henan, China
| | - Mengyao Zhan
- Department of Thoracic Surgery and Lung Transplantation, First Affiliated Hospital of Zhengzhou University, No. 1 Jian She Road, Zhengzhou, 450052, Henan, China
| | - Fuping Yan
- Central Surgery Department, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Huijie Li
- Central Surgery Department, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Yan Zhang
- Department of Thoracic Surgery and Lung Transplantation, First Affiliated Hospital of Zhengzhou University, No. 1 Jian She Road, Zhengzhou, 450052, Henan, China.
| | - Jindong Li
- Department of Thoracic Surgery and Lung Transplantation, First Affiliated Hospital of Zhengzhou University, No. 1 Jian She Road, Zhengzhou, 450052, Henan, China.
| | - Xiangnan Li
- Department of Thoracic Surgery and Lung Transplantation, First Affiliated Hospital of Zhengzhou University, No. 1 Jian She Road, Zhengzhou, 450052, Henan, China.
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Kang K, Wang S, Xiong F, Kai J, Wang J, Li B. Esophageal cancer with a double aortic arch: a case report and literature review. J Cardiothorac Surg 2022; 17:33. [PMID: 35277193 PMCID: PMC8915513 DOI: 10.1186/s13019-022-01774-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 02/19/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Double aortic arch (DAA) is an extremely rare vascular malformation, even more so when coexisting with esophageal cancer. METHODS We report a new case of DAA with esophageal cancer recently seen at our Thoracic Tumor Clinic and review cases of DAA coexisting with esophageal cancer reported in the literature of English language from 2010 to 2020. The purposes of our literature review were to explore how to best achieve radical esophagectomy while reducing postoperative complications. The clinical manifestations, diagnostic method, surgical approach, reconstruction route, and the extent of lymphadenectomy of esophageal cancer with DAA were analyzed in detail. RESULTS AND CONCLUSION For such patients, 3D computed tomography is necessary for preoperative diagnosis. The surgical approach should consider factors such as the location of the tumor in the esophagus and whether the tumor is surrounded by DAA, as well as the position of the descending aorta and the requirements for the surgical field for lymphadenectomy. If esophageal reconstruction is required, the retrosternal route is preferred. We recommend that only patients with positive results of intraoperative frozen biopsy of recurrent laryngeal nerve lymph nodes should undergo three-field lymphadenectomy, which may be the best method to achieve radical esophagectomy for middle and lower esophageal cancers with DAA while minimizing postoperative complications.
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Affiliation(s)
- Kai Kang
- Thoracic Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, 430079, China
| | - Sheng Wang
- Thoracic Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, 430079, China
| | - Fei Xiong
- Thoracic Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, 430079, China.
| | - Jindan Kai
- Thoracic Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, 430079, China.
| | - Jianjian Wang
- Thoracic Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, 430079, China
| | - Binfeng Li
- Thoracic Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, 430079, China
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Kumar NA, Usman N, Rajan K, Gaude YK. Esophageal Cancer and Double Aortic Arch: Right-Sided Thoracoscopic Esophagectomy and Reconstruction. J Gastrointest Cancer 2021; 52:355-358. [PMID: 32728992 DOI: 10.1007/s12029-020-00469-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Naveena An Kumar
- Department of Surgical Oncology, Manipal Comprehensive Cancer Care Center, Kasturba, Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, 576104, India.
| | - Nawaz Usman
- Department of Surgical Oncology, Manipal Comprehensive Cancer Care Center, Kasturba, Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, 576104, India
| | - Keshava Rajan
- Department of Surgical Oncology, Manipal Comprehensive Cancer Care Center, Kasturba, Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, 576104, India
| | - Yogesh K Gaude
- Department of Anesthesiology, Kasturba Medical College, Manipal Academy of Higher, Education (MAHE), Manipal, Karnataka, 576104, India
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Fujiwara H, Sato T, Okada N, Fujita T, Kojima T, Daiko H. Thoracoscopic esophagectomy with three-field lymphadenectomy for thoracic esophageal cancer in a patient with a double aortic arch: a report of a case. Surg Case Rep 2019; 5:80. [PMID: 31098683 PMCID: PMC6522582 DOI: 10.1186/s40792-019-0640-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 05/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We encountered an esophageal cancer patient with a double aortic arch (DAA) who underwent radical thoracoscopic esophagectomy with three-field lymph node dissection. A DAA generally makes it difficult to perform upper mediastinal lymph node dissection via both sides of the thoracic cavity. Furthermore, most patients with a DAA have a superior right aortic arch and right-sided descending aorta, which hampers radical esophagectomy with a typical right thoracic approach. We herein report our operative strategy of thoracoscopic esophagectomy via the left side of the thoracic cavity with a preceding cervical procedure. CASE PRESENTATION A 64-year-old man was diagnosed with esophageal squamous cell carcinoma in the upper esophagus at clinical Stage IIB (cT1bN1M0) according to the UICC-TNM classification 7th edition. First, we planned the preceding cervical procedure to complete upper mediastinal lymph node dissection, as the DAA prevented a bilateral thoracic approach to the upper mediastinum. We then planned the left thoracoscopic procedure to perform lymph node dissection below the left aortic arch, as the patient in our case had a right side-dominant DAA and right-sided descending aorta, as is common in such patients. We identified the bilateral recurrent laryngeal nerves during upper mediastinal lymph node dissection in the preceding cervical procedure and ultimately successfully resected the patient's esophageal cancer. CONCLUSION The cervical procedure preceding the left-thoracoscopic approach is reasonable for achieving radical esophagectomy for thoracic esophageal cancer in patients with a DAA.
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Affiliation(s)
- Hisashi Fujiwara
- Department of Esophageal Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwa-no-ha, Kashiwa, Chiba, 277-8577, Japan. .,Department of Esophageal Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Takuji Sato
- Department of Esophageal Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwa-no-ha, Kashiwa, Chiba, 277-8577, Japan
| | - Naoya Okada
- Department of Esophageal Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwa-no-ha, Kashiwa, Chiba, 277-8577, Japan.,Department of Esophageal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Takeo Fujita
- Department of Esophageal Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwa-no-ha, Kashiwa, Chiba, 277-8577, Japan
| | - Takashi Kojima
- Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Hiroyuki Daiko
- Department of Esophageal Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwa-no-ha, Kashiwa, Chiba, 277-8577, Japan.,Department of Esophageal Surgery, National Cancer Center Hospital, Tokyo, Japan
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