McKeown esophagectomy with concomitant median arcuate ligament release in a case of esophageal cancer with celiac artery stenosis
Abstract Background The celiac artery stenosis due to compression by median arcuate ligament (MAL) has been reported in many cases of pancreaticoduodenectomy, but not in cases of esophagectomy. Recently, the celiac artery stenosis due to MAL or arteriosclerosis has been reported to be associated wit...
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Japan Surgical Society
2022-01-01
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| Series: | Surgical Case Reports |
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| Online Access: | https://doi.org/10.1186/s40792-022-01359-z |
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| author | Keita Hanada Shigeru Tsunoda Satoshi Ogiso Tatsuto Nishigori Shigeo Hisamori Kazutaka Obama |
| author_facet | Keita Hanada Shigeru Tsunoda Satoshi Ogiso Tatsuto Nishigori Shigeo Hisamori Kazutaka Obama |
| author_sort | Keita Hanada |
| collection | DOAJ |
| description | Abstract Background The celiac artery stenosis due to compression by median arcuate ligament (MAL) has been reported in many cases of pancreaticoduodenectomy, but not in cases of esophagectomy. Recently, the celiac artery stenosis due to MAL or arteriosclerosis has been reported to be associated with the gastric tube necrosis or anastomotic leakage following Ivor–Lewis esophagectomy. Herein, we present the first reported case of esophageal cancer with celiac artery stenosis due to compression by the MAL successfully treated by McKeown esophagectomy and gastric tube reconstruction following prophylactic MAL release. Case presentation A 72-year-old female patient was referred to our department for esophagectomy. The patient had received two courses of neoadjuvant chemotherapy with 5-FU and cisplatin for T2N0M0 squamous cell carcinoma of the middle esophagus. Preoperative contrast-enhanced computed tomography (CECT) showed celiac artery stenosis due to compression by the MAL. The development of collateral arteries around the pancreatic head was observed without evidence of aneurysm formation. The patient reported no abdominal symptoms. After robot-assisted esophagectomy with mediastinal lymphadenectomy, gastric mobilization, supra-pancreatic lymphadenectomy, and preparation of the gastric tube were performed under laparotomy. Subsequently, the MAL was cut, and released to expose the celiac artery. Improved celiac artery blood flow was confirmed by decreased pulsatility index on intraoperative Doppler sonography. The operation was completed with the cervical esophagogastric anastomosis following cervical lymphadenectomy. Postoperative CECT on postoperative day 7 demonstrated increased celiac artery patency. The patient had an uncomplicated postoperative course thereafter. Conclusions Prophylactic MAL release may be considered in patients with celiac artery stenosis due to compression by the MAL on preoperative CECT for esophagectomy. |
| format | Article |
| id | doaj-art-ea31f80a952a4b38b9b4f54b4d0b3382 |
| institution | Kabale University |
| issn | 2198-7793 |
| language | English |
| publishDate | 2022-01-01 |
| publisher | Japan Surgical Society |
| record_format | Article |
| series | Surgical Case Reports |
| spelling | doaj-art-ea31f80a952a4b38b9b4f54b4d0b33822025-08-20T03:57:54ZengJapan Surgical SocietySurgical Case Reports2198-77932022-01-01811610.1186/s40792-022-01359-zMcKeown esophagectomy with concomitant median arcuate ligament release in a case of esophageal cancer with celiac artery stenosisKeita Hanada0Shigeru Tsunoda1Satoshi Ogiso2Tatsuto Nishigori3Shigeo Hisamori4Kazutaka Obama5Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kyoto UniversityDivision of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kyoto UniversityDivision of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto UniversityDivision of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kyoto UniversityDivision of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kyoto UniversityDivision of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kyoto UniversityAbstract Background The celiac artery stenosis due to compression by median arcuate ligament (MAL) has been reported in many cases of pancreaticoduodenectomy, but not in cases of esophagectomy. Recently, the celiac artery stenosis due to MAL or arteriosclerosis has been reported to be associated with the gastric tube necrosis or anastomotic leakage following Ivor–Lewis esophagectomy. Herein, we present the first reported case of esophageal cancer with celiac artery stenosis due to compression by the MAL successfully treated by McKeown esophagectomy and gastric tube reconstruction following prophylactic MAL release. Case presentation A 72-year-old female patient was referred to our department for esophagectomy. The patient had received two courses of neoadjuvant chemotherapy with 5-FU and cisplatin for T2N0M0 squamous cell carcinoma of the middle esophagus. Preoperative contrast-enhanced computed tomography (CECT) showed celiac artery stenosis due to compression by the MAL. The development of collateral arteries around the pancreatic head was observed without evidence of aneurysm formation. The patient reported no abdominal symptoms. After robot-assisted esophagectomy with mediastinal lymphadenectomy, gastric mobilization, supra-pancreatic lymphadenectomy, and preparation of the gastric tube were performed under laparotomy. Subsequently, the MAL was cut, and released to expose the celiac artery. Improved celiac artery blood flow was confirmed by decreased pulsatility index on intraoperative Doppler sonography. The operation was completed with the cervical esophagogastric anastomosis following cervical lymphadenectomy. Postoperative CECT on postoperative day 7 demonstrated increased celiac artery patency. The patient had an uncomplicated postoperative course thereafter. Conclusions Prophylactic MAL release may be considered in patients with celiac artery stenosis due to compression by the MAL on preoperative CECT for esophagectomy.https://doi.org/10.1186/s40792-022-01359-zEsophageal cancerEsophagectomyCeliac artery stenosisMedian arcuate ligamentDoppler ultrasonography |
| spellingShingle | Keita Hanada Shigeru Tsunoda Satoshi Ogiso Tatsuto Nishigori Shigeo Hisamori Kazutaka Obama McKeown esophagectomy with concomitant median arcuate ligament release in a case of esophageal cancer with celiac artery stenosis Surgical Case Reports Esophageal cancer Esophagectomy Celiac artery stenosis Median arcuate ligament Doppler ultrasonography |
| title | McKeown esophagectomy with concomitant median arcuate ligament release in a case of esophageal cancer with celiac artery stenosis |
| title_full | McKeown esophagectomy with concomitant median arcuate ligament release in a case of esophageal cancer with celiac artery stenosis |
| title_fullStr | McKeown esophagectomy with concomitant median arcuate ligament release in a case of esophageal cancer with celiac artery stenosis |
| title_full_unstemmed | McKeown esophagectomy with concomitant median arcuate ligament release in a case of esophageal cancer with celiac artery stenosis |
| title_short | McKeown esophagectomy with concomitant median arcuate ligament release in a case of esophageal cancer with celiac artery stenosis |
| title_sort | mckeown esophagectomy with concomitant median arcuate ligament release in a case of esophageal cancer with celiac artery stenosis |
| topic | Esophageal cancer Esophagectomy Celiac artery stenosis Median arcuate ligament Doppler ultrasonography |
| url | https://doi.org/10.1186/s40792-022-01359-z |
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