Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
Department of Gastroenterology, University Medical Center Utrecht, Utrecht, the Netherlands.
Anticancer Res. 2023 Aug;43(8):3553-3561. doi: 10.21873/anticanres.16533.
BACKGROUND/AIM: Esophagectomy for esophageal cancer is a complex surgical procedure with predefined surgical steps. Anatomical anomalies can offer additional challenges in case of surgical treatment. We present three cases of esophageal carcinoma with thoracic anatomical anomalies affecting the treatment strategy. The aim was to address the anatomical challenges of the anomalies and their impact on surgery as well as elaborate on possible solutions.
We present three patient cases with anomalies of the thoracic anatomy. The first patient had a tumor with suspected ingrowth in an arteria lusoria. Restaging after definitive chemoradiotherapy showed progression of disease but without previously noted signs of vascular wall invasion and salvage robot-assisted minimally invasive esophagectomy (RAMIE) was performed. The second patient had an azygos lobe of the lung and underwent RAMIE after neoadjuvant chemoradiotherapy. The azygos vein was clipped, and paratracheal lymph node dissection was performed, however with limited extent at the right side due to the anatomical situation. The third patient was diagnosed with a right aortic arch, where the aortic arch transverses over the right bronchus instead of the left and descends to the right of and posterior to the esophagus and trachea. Treatment included definitive chemoradiotherapy (dCRT) without surgery, given the anatomical situation and a complete clinical response to dCRT of a squamous cell carcinoma.
Thoracic anatomical anomalies are rare entities, which can be asymptomatic. Clinical implications can arise in combination with diagnosis of esophageal cancer and the need for surgical treatment. Therefore, detailed information regarding possible anomalies must be obtained prior to surgery and potential challenges have to be taken into consideration. Resection of related structures with tumor ingrowth can be considered in selected cases to achieve a radical resection.
背景/目的：食管癌切除术是一种复杂的外科手术，有既定的手术步骤。解剖异常在手术治疗时会带来额外的挑战。我们报告了 3 例胸段解剖异常的食管癌病例，这些异常影响了治疗策略。目的是解决异常的解剖挑战及其对手术的影响，并详细阐述可能的解决方案。
我们报告了 3 例具有胸段解剖异常的患者病例。第一例患者的肿瘤有疑似侵犯奇静脉的迹象。根治性放化疗后重新分期显示疾病进展，但没有先前发现的血管壁侵犯迹象，因此进行了挽救性机器人辅助微创食管切除术（RAMIE）。第二例患者有奇静脉叶，在新辅助放化疗后接受了 RAMIE。奇静脉被夹闭，气管旁淋巴结清扫，但由于解剖情况，右侧清扫范围有限。第三例患者被诊断为右位主动脉弓，主动脉弓从右侧支气管穿过，而不是左侧，然后降落在食管和气管的右侧和后方。由于解剖情况和鳞状细胞癌对 dCRT 的完全临床反应，治疗包括根治性放化疗（dCRT）而无需手术。
胸段解剖异常是罕见的实体，可能无症状。在诊断为食管癌和需要手术治疗时，可能会出现临床影响。因此，在手术前必须获得有关可能异常的详细信息，并考虑潜在的挑战。在某些情况下，可以考虑切除与肿瘤浸润相关的结构以实现根治性切除。
