Determination of the best surgical strategy for thoracic esophageal resection concurrent with double aortic arch using a three-dimensional model: a case report.

BACKGROUND: A double aortic arch (DAA) is a relatively rare vascular malformation, which rarely causes problems once the patients reach adulthood. However, a DAA makes an esophageal cancer surgery difficult to perform, especially during upper mediastinal dissection. Herein, we report a strategy for surgery in esophageal cancer patients concurrent with DAA.

CASE DESCRIPTION: A 73-year-old man was diagnosed with middle thoracic esophageal cancer of cT3N4M0 stage III (UICC-TNM 7th) concurrent with DAA. After two courses of neoadjuvant chemotherapy, surgical intervention was planned. To develop a surgical strategy for an esophagectomy with this complicated malformation, we created a three-dimensional printer model for this case. According to this simulation, the bilateral thoracoscopic approach with prone position seemed to be an ideal method for upper mediastinal dissection. As we expected, the dissection of upper mediastinum was difficult only with the right-side approach; especially, the oral side of esophagus posterior to the right aortic arch (RAA) was impossible to dissect from the right side. By switching the approach from left side, oral esophagus was easily dissected by retracting the oral esophagus from the cranial side of the left aortic arch (LAA). Surgery was successfully performed, and the patient was discharged 26 days after surgery without major complications.

CONCLUSIONS: To the best of our knowledge, this is the first surgical report using a three-dimensional printer for esophageal cancer. The bilateral approach is appropriate for esophageal cancer surgery concurrent with a DAA. A three-dimensional printer is useful for simulating esophageal surgery with major vascular malformations.