Thoracoscopic esophagectomy in the prone position for esophageal cancer with right aortic arch

Abstract

We report a case of esophageal cancer with a right aortic arch (RAA).The patient was a 61-year-old woman. She was admitted due to dysphagia found by endoscopic examination which revealed type 3 advanced esophageal cancer in the lower third of the esophagus. Histological diagnosis of the biopsy was mucinous adenocarcinoma. Routine chest X-ray showed that she had an RAA and CT showed lower esophageal wall thickening and metastatic abdominal lymph nodes. Three dimensional CT (3D-CT) showed a mirror-image type of RAA (Edward's type III A1) and Kommerell's diverticulum of the descending aorta. The esophageal cancer was diagnosed as cT3N1M0 stage III. After two courses of neoadjuvant chemotherapy, the patient underwent a left thoracoscopic esophagectomy in the prone position. We were able to identify the Kommerell's diverticulum, left-sided ligamentum arterosum originating from the Kommerell's diverticulum, which is known as a vascular ring, and left recurrent laryngeal nerve. The patient underwent the reconstruction through a retrosternal route. In the treatment of esophageal cancer with RAA, it is very important that we recognize the anatomical relationship by using preoperative 3D-CT. A left thoracoscopic esophagectomy approach in the prone position may help us to easily identify its unusual anatomical structure and handle them safely.