Three cases of esophageal cancer with aberrant right subclavian artery treated by thoracoscopic esophagectomy

An aberrant right subclavian artery (ARSA) is an anatomical abnormality that occurs at a frequency of 0.4-2 %. It is important to be aware of this abnormality when performing radical esophagectomy for esophageal cancer because many patients with an ARSA have a right nonrecurrent inferior laryngeal nerve (NRILN) and right thoracic duct. We report three cases of esophageal cancer with ARSA treated by thoracoscopic esophagectomy. Case 1 was a 59-year-old woman with a relapse of a thoracic esophageal cancer after definitive chemoradiotherapy (CRT). Case 2 was a 76-year-old man with upper thoracic esophageal cancer who had received no treatment before the surgery. Case 3 was a 69-year-old man with upper thoracic esophageal cancer pretreated with neoadjuvant CRT. It was possible to predict an ARSA by computed tomography and the right thoracic ducts by magnetic resonance imaging before surgery in all three cases. Thoracoscopic esophagectomy with two-field lymph node dissection was performed, and the NRILN and the right thoracic duct were detected and preserved in all three cases. Because of ARSA, the operative field is limited around the left recurrent nerve, so a careful procedure is needed to avoid nerve palsy.