Esophageal Cancer and Double Aortic Arch: Right-Sided Thoracoscopic Esophagectomy and Reconstruction

Excerpt

Aortic arch anomalies occur due to the failure of normal regression of one or more segments of six pairs of aortic arches that arise from truncus arteriosus [1]. These anomalies may include the combination of a double aortic arch (DAA) with an equal/smaller right or left arch and a right- or left-sided descending thoracic aorta [1]. The DAA results from the persistence of both right and left arches, as against the normal embryological development, where one of the six arches persist as ductus arteriosus and is classified as a Stewart & Edwards type I vascular malformation [1, 2]. The DAA forms a complete “vascular ring,” which encircles trachea and esophagus [1]. It is known to cause respiratory symptoms and dysphagia in infancy [1, 3]. However, it is detected by chance in adults, as they are usually asymptomatic [1, 3]. The prevalence of aortic arch anomalies ranges from 1 to 2% and incidence of DAA is 46–76% among the reports of vascular rings [4, 5]. Association of DAA with esophageal cancer is rare [3, 6] and makes surgery very difficult and challenging due to the complex anatomy. There are few previously reported cases, where surgery was performed through right or left thoracotomy and gastric tube was transferred through retrosternal route or through the left thorax [3, 6‐9]. There is only one report of left thoracoscopic approach and retrosternal reconstruction [2]. …