Diagnosis and surgical treatment of esophageal carcinoma with coexistent intrathoracic vascular malformations

Abstract

Background: The anomaly of intrathoracic large vessels might not only compress the esophagus resulting in dysphagia, but also hinder esophagectomy, even leading to uncontrolled massive hemorrhaging. This paper reviews our experience of seven patients with this diagnosis and their treatment. Methods: From January 2007 through January 2012, among patients admitted with esophageal carcinoma, there were seven patients confirmed to have coexisted intrathoracic vascular anomalies. They were six men and one woman, aged 52 to 63 (mean 58.42). The vascular anomalies included aberrant right subclavian artery (ARSA) in three cases, post-aortic left innominate vein (PALIV) in two cases, and one case each of right aortic arch (RAA) and pseudoaneurysm of aortic isthmus (PAAI). Their diagnosis, surgical strategy, and outcome were reviewed. Results: The vascular anomalies were missed by esophagography and endoscopy, but all identified by enhanced chest computed tomography (CT). Surgery was planned according to the anatomic features of the anomalies. ARSA did not need special management. RAA underwent left thoracotomy in order to dissect the aortopulmonary arterial ligament and to facilitate the mobilization of the esophagus. PAAI had preoperative aortic stenting to prevent unexpected aortic rupture. Prophylactic ligation of thoracic duct was performed on all patients and no postoperative chylothorax was documented. Conclusions:The coexistence of intrathoracic vascular malformations with esophageal carcinoma is rare, but easily missed in routine X-ray and endoscopy. Enhanced chest CT must be performed to confirm. Surgery should be designed individually in consideration of the anatomic features of the vascular anomalies. A routine prophylactic ligation of the thoracic duct is recommended.

Successful resection of esophageal carcinosarcoma in presence of right aortic arch: a case report

“…According to the literature, most reported cases of esophageal cancer with coexisting RAA adopted a left thoracotomy approach. [15] In our case, because the entire length of the thoracic esophagus was involved, we adopted a left thoracotomy and left cervical anastomosis. Stomach mobilization was done through the chest instead of abdominal approach according to the custom of Chinese thoracic surgery.…”

“…RAA is a rare condition that can be part of a situs inversus syndrome or occurs in isolation. [15] A few cases of RAA accompanying esophageal cancer have been reported, [4][5][6] but none of them were ECS. According to the literature, most reported cases of esophageal cancer with coexisting RAA adopted a left thoracotomy approach.…”