Abstract
An 80-year-old man underwent subtotal esophagectomy through right thoracotomy with 2-field dissection, and high intrathoracic esophagogastrostomy for cancer of the middle thoracic esophagus associated with the aberrant right subclavian artery < pT1b, pN1 (2/31), sM0, and fStage II >. Following postoperative chemoradiotherapy, no recognizable recurrence had occurred until 6 years and 2 months elapsed, when the patient was seen at our hospital because of massive hematemesis. On arrival at our hospital, he was in a state of shock. Upper gastrointestinal endoscopy revealed projectile bleeding from the esophagogastrostomy site. Arteriogram of the right subclavian artery visualized defluxion of contrast medium from the right subclavian artery to the gastrointestinal tract. So a stent was placed at the right subclavian artery-anastomotic fistula that was successful to stop the bleeding. However, he died of progressive worsening of the general condition due to prolonged shock state.
In surgical treatment of esophageal cancer associated with the aberrant right subclavian artery, a right subclavian artery-anastomotic fistula can occur like in this case. In order to avoid such events, we can employ either antethoracic or retrosteral route or we must place some tissue like the greater omentum between the vessel and the reconstructed organ.
