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LETTER TO THE EDITOR
Year : 2013  |  Volume : 9  |  Issue : 2  |  Page : 336-337

Esophageal cancer associated with right aortic arch


Department of Surgical Oncology, Cancer Institute (WIA), Adyar, Chennai, India

Date of Web Publication13-Jun-2013

Correspondence Address:
Arvind Krishnamurthy
Surgical Oncology, Cancer Institute (WIA), 36, Sardar Patel Rd, Adyar, Chennai - 600 020
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.113429

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How to cite this article:
Krishnamurthy A. Esophageal cancer associated with right aortic arch. J Can Res Ther 2013;9:336-7

How to cite this URL:
Krishnamurthy A. Esophageal cancer associated with right aortic arch. J Can Res Ther [serial online] 2013 [cited 2019 Sep 15];9:336-7. Available from: http://www.cancerjournal.net/text.asp?2013/9/2/336/113429

Sir,

Right aortic arch is a rare congenital vascular anomaly. Surgical resection of esophageal cancer patients with this anomaly is extremely rare. [1],[2],[3],[4] In patients with a right sided aortic arch, the aorta surrounds and there by compresses the esophagus and trachea. This also results in the deviation of the course of the recurrent laryngeal nerve. Although the most common thoraco-abdominal approach for resection of esophageal cancer is a right thoracotomy, the favored approach for resection of esophageal carcinoma in the presence of a right aortic arch is a left thoracotomy. [1],[2],[3],[4] We recently performed a transthoracic esophagectomy (TTE) via a right thoracotomy approach for an esophageal cancer patient with a right aortic arch; to the best of our knowledge this approach has never been reported before.

A 30-year-old gentleman was evaluated for progressive dysphagia for two months. A barium study [Figure 1] detected a shadow defect on the right side of the thoracic esophagus due to a due to right aortic arch, which was confirmed on a CT scan of the chest and upper abdomen [Figure 2]. Further evaluation by an endoscopy revealed a polypoidal growth 22-24 cm in the upper thoracic esophagus, biopsy of which suggested a malignancy, invasion could not be commented upon. The patient was taken up for a TTE which was successfully completed by a right thoracotomy approach. [Figure 3] An extended two field lymphadenectomy was performed; the stomach tube was fashioned along the posterior mediastinum for a cervical anastomosis. The final histopathology was a pT1N0M0, well differentiated squamous cell carcinoma of the esophagus; the patient continues to be on regular follow up.
Figure 1: A barium study detected a shadow defect on the right side of the thoracic esophagus due to a due to right aortic arch

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Figure 2: A CT scan of the chest showing the right sided aortic arch

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Figure 3: Intra operative photograph of a right thoracotomy showing the mobilized esophagus and the right sided aortic arch

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The Edwards classification of aortic anomalies is based on the theoretical concept of the development of the aortic arch. Right aortic arch belongs to Group III of this classification. Its variations are divided into three types and our case was Type IIIA. The main symptom of right aortic arch is dysphagia due to compression of the esophagus by the vascular ring created by the aortic arch; dysphagia was however not noted in our patient prior to the development of esophageal cancer. Isolated case reports of surgery for esophageal cancer patients with a right sided aortic arch have been periodically reported. [1],[2],[3],[4] The mean age in the reported cases was around 63 years with a significant male preponderance. Majority of the cases belonged to Edwards Type IIIB classification, followed by Type IIIA [2] as seen in our case. In conclusion the altered anatomy of the mediastinum due to a right sided aortic arch poses unique challenges to esophageal cancer surgeons.

 
 > References Top

1.Yamamoto Y, Watanabe Y, Horiuchi A, Yoshida M, Sugishita H, Nakagawa H, et al. Esophageal cancer resection associated with a right aortic arch after descending aortic graft replacement. Hepato­gastroenterology 2009;56:395-7.  Back to cited text no. 1
    
2.Shimakawa T, Naritaka Y, Wagatuma Y, Konno S, Katsube T, Ogawa K. Esophageal cancer associated with right aortic arch : A case study. Anticancer Res 2006;26:3733-8.   Back to cited text no. 2
    
3.Noguchi H, Naomoto Y, Haisa M, Yamatsuji T, Shigemitsu K, Ohkawa T, et al. Esophageal cancer associated with right aortic arch : Report of two cases. Dis Esophagus 2003;16:332-4.  Back to cited text no. 3
    
4.Hanazono K, Natsugoe S, Kubo M, Sakoda M, Baba M, Aikou T. Esophageal cancer associated with the right aortic arch : A case study. Hepatogastroenterology 2003;50:1330-2.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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