Esophageal cancer resection and right aortic arch: successful approach through left thoracotomy

Esophagectomy is usually performed through a right thoracotomy because of the left position of the aortic arch. We report four cases of right-sided aortic arches in patients admitted for esophageal carcinoma. Two cases were included in total situs inversus syndrome and were thus diagnosed before esophageal carcinoma diagnosis. In these cases, the standard surgical technique was modified in a mirror image fashion and was thus performed through a left thoracotomy. The two other cases were of isolated right aortic arch and were discovered during preoperative evaluation of the esophageal carcinoma. Such asymptomatic anatomical variations have to be recognized by the esophageal surgeon because of the possible association of heart malformation and risk of iatrogenic aortotracheal or aortoesophageal fistula during tracheal or esophageal endoscopy, biopsy or intubation. Usually, esophageal resection and anastomosis are impossible through a right thoracotomy and left thoracotomy is required.