Fujiwara Hisashi, Sato Takuji, Okada Naoya, Fujita Takeo, Kojima Takashi, Daiko Hiroyuki
Department of Esophageal Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwa-no-ha, Kashiwa, Chiba, 277-8577, Japan.
Department of Esophageal Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
Surg Case Rep. 2019 May 16;5(1):80. doi: 10.1186/s40792-019-0640-7.
We encountered an esophageal cancer patient with a double aortic arch (DAA) who underwent radical thoracoscopic esophagectomy with three-field lymph node dissection. A DAA generally makes it difficult to perform upper mediastinal lymph node dissection via both sides of the thoracic cavity. Furthermore, most patients with a DAA have a superior right aortic arch and right-sided descending aorta, which hampers radical esophagectomy with a typical right thoracic approach. We herein report our operative strategy of thoracoscopic esophagectomy via the left side of the thoracic cavity with a preceding cervical procedure.
A 64-year-old man was diagnosed with esophageal squamous cell carcinoma in the upper esophagus at clinical Stage IIB (cT1bN1M0) according to the UICC-TNM classification 7th edition. First, we planned the preceding cervical procedure to complete upper mediastinal lymph node dissection, as the DAA prevented a bilateral thoracic approach to the upper mediastinum. We then planned the left thoracoscopic procedure to perform lymph node dissection below the left aortic arch, as the patient in our case had a right side-dominant DAA and right-sided descending aorta, as is common in such patients. We identified the bilateral recurrent laryngeal nerves during upper mediastinal lymph node dissection in the preceding cervical procedure and ultimately successfully resected the patient's esophageal cancer.
The cervical procedure preceding the left-thoracoscopic approach is reasonable for achieving radical esophagectomy for thoracic esophageal cancer in patients with a DAA.
我们遇到一例患有双主动脉弓（DAA）的食管癌患者，该患者接受了根治性胸腔镜食管切除术并进行了三野淋巴结清扫。双主动脉弓通常使得经胸腔两侧进行上纵隔淋巴结清扫变得困难。此外，大多数双主动脉弓患者具有右上位主动脉弓和右侧降主动脉，这妨碍了采用典型的右胸入路进行根治性食管切除术。我们在此报告我们通过胸腔左侧先行颈部手术进行胸腔镜食管切除术的手术策略。
一名64岁男性根据UICC-TNM第7版分类被诊断为食管上段鳞状细胞癌，临床分期为IIB期（cT1bN1M0）。首先，由于双主动脉弓妨碍了对上纵隔进行双侧胸腔入路，我们计划先行颈部手术以完成上纵隔淋巴结清扫。然后，由于我们病例中的患者具有右侧优势双主动脉弓和右侧降主动脉，这在这类患者中很常见，我们计划进行左侧胸腔镜手术以在左主动脉弓下方进行淋巴结清扫。在先行的颈部手术对上纵隔淋巴结清扫过程中，我们识别了双侧喉返神经，最终成功切除了患者的食管癌。
对于患有双主动脉弓的胸段食管癌患者，先行颈部手术再行左侧胸腔镜手术对于实现根治性食管切除术是合理的。
