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Curative Resection for Thoracic Esophageal Carcinoma with an Aberrant Right Subclavian Artery: A Case Report
Nobuyuki Nishida1, Shinsuke Takeno1, Makoto Ikenoue1
1Department of Surgery, Faculty of Medicine, Miyazaki University, Miyazaki, Japan.
Introduction:
Esophagectomy in the presence of an aberrant right subclavian artery (ARSA) is rare, and the anomalous vascular anatomy can complicate lymphadenectomy because of the risk of nerve injury.
Case Presentation:
The patient was a 67-year-old man who presented with pharyngeal discomfort. Right pyriform sinus cancer and middle thoracic esophageal cancer were detected. After neoadjuvant chemotherapy with docetaxel, cisplatin, and 5-fluorouracil for the esophageal cancer, the pyriform sinus cancer disappeared, indicating a complete response. Accordingly, esophagectomy with reconstruction using a gastric conduit was planned, with preservation of the hypopharynx. Because the presence of an ARSA had been recognized preoperatively, cervical lymphadenectomy was first performed via a cervical approach. Esophagectomy was performed thoracoscopically without injury to the nonrecurrent inferior laryngeal nerve (NRILN).
Conclusions:
Esophagectomy in a patient with an ARSA was performed while preserving the NRILN by initiating cervical lymphadenectomy before the thoracoscopic procedure.
