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Preoperative 3D-CT evaluation of the bronchial arteries in transmediastinal radical esophagectomy for esophageal cancer

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Abstract

Background

In transmediastinal esophagectomy (TME) with equivalent lymphadenectomy to transthoracic procedure, an understanding of surgical anatomy in the deep mediastinum near the aortic arch or tracheal bifurcation is essential for the safe procedure. The present study aimed to evaluate the bronchial arteries (BAs) with preoperative 3D-CT in TME.

Methods

Seventy-nine patients with thoracic esophageal cancer undergoing TME were examined by preoperative 3D-CT to evaluate BA variations in the number, branching pattern, and mediastinal course. For the right BAs (RBAs) crossing the esophagus, the mediastinal courses in transcervical view were classified in relation to the esophagus and tracheobronchi and compared with surgical findings.

Results

A total of 107 RBAs (1.35/person) were confirmed on preoperative 3D-CT. Of these, 61 (57.0%) crossed the esophagus dorsally (type Ed), and the remaining 46 (43.0%) crossed the esophagus ventrally (type Ev). During the left transcervical procedure, all type Ed RBAs were identified and mostly preserved (57/61, 93.4%) whereas most type Ev RBAs were identified (39/46, 84.8%), but more than half were sacrificed (26/46, 56.5%) for lymphadenectomy. The blood loss during the transcervical procedure was 17.0 ± 55.8 ml. The total number of dissected mediastinal lymph nodes was 23.7 ± 9.3. There were no significant complications related to extensive lymphadenectomy.

Conclusions

Preoperative 3D-CT evaluation is useful to understand the mediastinal courses of BAs specific to the transcervical approach, which may allow BAs to be handled more carefully according to the type during surgery, contributing to a safer procedure in the deep mediastinum.

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Acknowledgements

The authors appreciate the contribution of the radiological technologists at the Kyoto Prefectural University of Medicine Hospital for creating 3D-CT images.

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Authors and Affiliations

  1. Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 6028566, Japan

    Tomohito Maeda, Hitoshi Fujiwara, Hirotaka Konishi, Atsushi Shiozaki, Toshiyuki Kobayashi, Takuma Ohashi, Toshiyuki Kosuga, Takeshi Kubota, Kazuma Okamoto & Eigo Otsuji

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  1. Tomohito Maeda
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  2. Hitoshi Fujiwara
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  3. Hirotaka Konishi
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  4. Atsushi Shiozaki
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  5. Toshiyuki Kobayashi
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  6. Takuma Ohashi
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  7. Toshiyuki Kosuga
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  8. Takeshi Kubota
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  9. Kazuma Okamoto
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  10. Eigo Otsuji
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Correspondence to Hitoshi Fujiwara.

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The authors declare no conflict of interest for this article.

Ethical statement

This work was approved by the Ethics Review Board of Kyoto Prefectural University of Medicine (ERB-C-1414-1). Written informed consent to the treatments and participation in the present study was received from all patients.

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Maeda, T., Fujiwara, H., Konishi, H. et al. Preoperative 3D-CT evaluation of the bronchial arteries in transmediastinal radical esophagectomy for esophageal cancer. Esophagus 19, 77–84 (2022). https://doi.org/10.1007/s10388-021-00870-w

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  • DOI: https://doi.org/10.1007/s10388-021-00870-w

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