Surgery Today

, Volume 48, Issue 3, pp 346–351 | Cite as

Spatial relationships of the bronchial arteries to the left recurrent laryngeal nerve in the sub-aortic arch area

  • Ken Hayasaka
  • Hajime Ishida
  • Ryosuke Kimura
  • Tadashi Nishimaki
Original Article



To safely perform lymphadenectomy in the sub-aortic arch area during esophagectomy for esophageal cancer, we investigated the spatial relationships between the bronchial arteries (BAs) and the left recurrent laryngeal nerve (LRLN).


For this macro-anatomical study, 72 cadavers were used.


Of the 195 dissected BAs, 15 (7.7%) arteries ran dorsally across the LRLN. Such a running pattern of the BA was found in 15 (20.8%) of the 72 cadavers. Fourteen (93.3%) of the 15 arteries ran anteriorly along the left side of the esophagus, and 13 (86.7%) passed further to the lateral side of the left main bronchus to reach the ventral surface of the tracheobronchus; we named this running pattern “Type III”. Of the 51 arteries with the Type III pattern, 25.5% ran across the dorsal side of the LRLN.


Approximately 20% of the cadavers had BAs running dorsally to the LRLN in the sub-aortic arch area. Most of these arteries had the Type III pattern. One-quarter of the BAs with the Type III pattern showed this running pattern. Care must be practiced to safely perform lymphadenectomy for esophageal cancer in patients with Type III BAs.


Esophageal cancer Lymphadenectomy Bronchial artery Left recurrent laryngeal nerve Anatomy 



The authors appreciate the contribution of the Deigo-Kai, the voluntary body donation organization of the University of the Ryukyus, for allowing our macro-anatomical studies of the cadavers.

Compliance with ethical standards

Conflict of interest

The authors declare no conflicts of interest in association with this study.


  1. 1.
    Nishimaki T, Suzuki T, Kanda T, Obinata I, Komukai S, Hatakeyama K. Extended radical esophagectomy for superficially invasive carcinoma of the esophagus. Surgery. 1999;125:142–7.CrossRefPubMedGoogle Scholar
  2. 2.
    Kanemura T, Makino T, Miyazaki Y, Takahashi T, Kurokawa Y, Yamasaki M, et al. Distribution patterns of metastases in recurrent laryngeal nerve lymph nodes in patients with squamous cell esophageal cancer. Dis Esophagus. 2017;30:1–7.PubMedGoogle Scholar
  3. 3.
    D’journo X-B, Michelet P, Avaro J-P, Trousse D, Giudicelli R, Fuentes P, et al. Respiratory complications after oesophagectomy for cancer. Rev Mal Respir. 2008;25:683–94.CrossRefPubMedGoogle Scholar
  4. 4.
    Maruyama K, Motoyama S, Sato Y, Hayashi K, Usami S, Minamiya Y, et al. Tracheobronchial lesions following esophagectomy: erosions, ulcers, and fistulae, and the predictive value of lymph node-related factors. World J Surg. 2009;33:778–84.CrossRefPubMedGoogle Scholar
  5. 5.
    Bartels HE, Stein HJ, Siewert JR. Tracheobronchial lesions following oesophagectomy: prevalence, predisposing factors and outcome. Br J Surg. 1998;85:403–6.CrossRefPubMedGoogle Scholar
  6. 6.
    Taniyama Y, Miyata G, Kamei T, Nakano T, Abe S, Katsura K, et al. Complications following recurrent laryngeal nerve lymph node dissection in oesophageal cancer surgery. Interact Cardiovasc Thorac Surg. 2015;20:41–6.CrossRefPubMedGoogle Scholar
  7. 7.
    Hayasaka K, Ishida H, Kimura R, Nishimaki T. A new anatomical classification of the bronchial arteries based on the spatial relationships to the esophagus and the tracheobronchus. Surg Today. 2017;47:883–90.CrossRefPubMedGoogle Scholar
  8. 8.
    Eid N, Otsuki Y. Anomalous bronchial arteries with surgically important relationships to abnormal recurrent laryngeal nerve and thoracic duct. Clin Anat. 2010;23:897–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Kasai T, Chiba S. Macroscopic anatomy of the bronchial arteries. Anat Anz. 1979;145:166–81.PubMedGoogle Scholar
  10. 10.
    Boyden EA. The developing bronchial arteries in a fetus of the twelfth week. Am J Anat. 1970;129:357–68.CrossRefPubMedGoogle Scholar
  11. 11.
    Boyden EA. The time lag in the development of bronchial arteries. Anat Rec. 1970;166:611–4.CrossRefPubMedGoogle Scholar
  12. 12.
    O’Rahilly R, Boyden EA. The timing and sequence of events in the development of the human respiratory system during the embryonic period proper. Z Anat Entwicklungsgesch. 1973;141:237–50.CrossRefPubMedGoogle Scholar
  13. 13.
    Steinberg JL, Khane GJ, Fernandes CM, Nel JP. Anatomy of the recurrent laryngeal nerve: a redescription. J Laryngol Otol. 1986;100:919–27.CrossRefPubMedGoogle Scholar
  14. 14.
    Licata RH. The human embryonic heart in the ninth week. Am J Anat. 1954;94:73–125.CrossRefPubMedGoogle Scholar
  15. 15.
    Rana MS, Sizarov A, Christoffels VM, Moorman AFM. Development of the human aortic arch system captured in an interactive three-dimensional reference model. Am J Med Genet Part A. 2014;164:1372–83.CrossRefGoogle Scholar
  16. 16.
    Fujita H, Kawahara H, Hidaka M, Nagano T, Yoshimatsu H. An experimental study on viability of the devascularized trachea. Jpn J Surg. 1988;18:77–83.CrossRefPubMedGoogle Scholar
  17. 17.
    Fujita H, Hawahara H, Yamana H, Shirohazu G, Yoshimura Y, Minami T, et al. Mediastinal lymphnode dissection procedure during esophageal cancer operation-carefully considered for preserving respiratory function. Jpn J Surg. 1988;18:31–4.CrossRefPubMedGoogle Scholar
  18. 18.
    Morita Y, Takase K, Ichikawa H, Yamada T, Sato A, Higano S, et al. Bronchial artery anatomy: preoperative 3D simulation with multidetector CT. Radiology. 2010;255:934–43.CrossRefPubMedGoogle Scholar
  19. 19.
    Wada T, Takeuchi H, Kawakubo H, Nakamura R, Oyama T, Takahashi T, et al. Clinical utility of preoperative evaluation of bronchial arteries by three-dimensional computed tomographic angiography for esophageal cancer surgery. Dis Esophagus. 2013;26:616–22.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Japan KK 2017

Authors and Affiliations

  • Ken Hayasaka
    • 1
  • Hajime Ishida
    • 2
  • Ryosuke Kimura
    • 2
  • Tadashi Nishimaki
    • 1
  1. 1.Department of Digestive and General Surgery, Graduate School of MedicineUniversity of the RyukyusOkinawaJapan
  2. 2.Department of Human Biology and Anatomy, Graduate School of MedicineUniversity of the RyukyusOkinawaJapan

Personalised recommendations