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[Objective] Intrathoracic great vessels accompany the full course of the esophagus in chest. The anomalies of these vessels can not only result in dysphagia symptom by direct compression, but also make the resection of esophageal cancer more difficult due to the malformation or even direct invasion of these vessels. The aim of this study is to summarize our experience in diagnosis and surgical treatment on 7 patients with esophageal cancer and coexistent intrathoracic great vessel anomalies.
[Methods] From January 2007 through November 2012, 1032 patients with esophageal carcinoma underwent cure intent esophagectomy. Among them there were 7 patients with coexistent intrathoracic great vessel anomalies (0.68%), including aberrant right subclavian artery (ARSA) in 3 patients, abnormal left brachiocephalic vein drainage in 2, right aortic arch (RAA) in 1 and aortic isthmus pseudoaneurysm in 1. They were 6 males and 1 female, with an average age of 58.42 years. Their examination findings and surgical treatment result were retrospectively analyzed.
[Results] The vessel anomalies were all missed on preoperative routine esophageal barium study and endoscopy. They were mostly identified by enhanced chest CT, some with the help of 3D vessel reconstruction or angiogram. During operation, the aortic malformation needed additional management: patient with RAA had ductus arteriusus ligation and dissection to facilitate the mobilization of the esophagus via left thoracotomy, while the aortic pseudoaneurysm underwent endovascular stent implantation before esophagectomy via right thoracotomy. All the other anomalies did not need special treatment, while caution was needed when performed lymphadenectomy due to the varied right recurrent laryngeal nerve or abnormal vein drainage. Besides, the thoracic duct was routinely ligated. All patients were recovered and discharged unevenly.
[Conclusion] The intrathoracic great vessel anomalies that coexisted with esophageal carcinoma are easily neglected on esophageal barium study or endoscopy. Therefore, enhanced chest CT should be a preoperative routine examination, with additional angiogram or 3D reconstruction. The vessel anomaly might interfere the mobilization of the esophagus and need be clarified before the operation. Some need pretreatment like ductus arteriusus ligation or endovascular stent implantation to facilitate the esophageal mobilization. A careful lymphadenectomy and prophylactic ligation of thoracic duct are recommended to avoid associated complications. If necessary, the abnormal vessel can be dissected to prevent uncontrolled bleeding.