A Case of Esophageal Cancer Associated with Right Aortic Arch

Abstract

A 76-year-old man admitted for dysphagia was found in preoperative examination to have advanced esophageal cancer in the upper thoracic esophagus. Three dimensional 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 (Edwards IIIB). The esophageal cancer was located in the upper thoracic esophagus and it was diagnosed as Ut, cT3N0M0, cStage II squamous cell carcinoma according to the Japanese Classification of Esophageal Cancer. The patient underwent a subtotal esophagectomy via a left thoracotomy and reconstruction using a gastric tube through the retrosternal route. There was an aberrant left subclavian artery arising from a Kommerell's diverticulum at the proximal descending aorta, and it was also confirmed that the left recurrent laryngeal nerve looped around the ductus arteriosus between the diverticulum and the left pulmonary artery. The adjacent left recurrent laryngeal nerve was resected along with the tumor due to a suspected tumor invasion, and formed anastomosis with the vagus nerve following cervical lymph node dissection. A thorough preoperative evaluation of vascular anatomy including the use of 3D-CT is thus useful in surgery for esophageal carcinoma associated with right aortic arch.