A case report of esophageal and gastric cancer resection with right aortic arch

Abstract

A 63-year-old man admitted for dysphagia and body weight loss was found in preoperative examination to have advanced esophageal cancer in the lower third of the esophagus and early gastric cancer in the gastric cardia. The former was diagnosed as cT3N2M0 Stage III squamous cell carcinoma, and the latter was diagnosed as cT1bN0 Stage IA adenocarcinoma according to the Japanese classification on esophageal and gastric carcinoma. Threedimensional computed tomography (3D-CT) showed a right aortic arch with an aberrant left subclavian artery and ductus arteriosus originating from a diverticulum at the descending aorta (Edward's type IIIB). After preoperative chemotherapy, the patient underwent a subtotal esophagectomy via a left thoracotomy and a 3-field lymph node dissection, followed by a high intrathoracic esophagogastrostomy. Through the careful preoperative assessment, we could safely deal with ductus arteriosus and successfully preserve the left recurrent laryngeal nerve. We present very clear intraoperative pictures revealing the anatomical positional relationship of each organ. In addition, we discuss important controversial issues associated with the reconstructive procedure and lymph node dissection along the right recurrent laryngeal nerve, and provided our suggestions. © 2013 The Japanese Society of Gastroenterological Surgery.