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      McKeown esophagectomy with concomitant median arcuate ligament release in a case of esophageal cancer with celiac artery stenosis

      case-report

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          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.

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          Most cited references31

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          Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.

          Daniel Dindo, Nicolas Demartines, Pierre-Alain Clavien (2004)
          Although quality assessment is gaining increasing attention, there is still no consensus on how to define and grade postoperative complications. This shortcoming hampers comparison of outcome data among different centers and therapies and over time. A classification of complications published by one of the authors in 1992 was critically re-evaluated and modified to increase its accuracy and its acceptability in the surgical community. Modifications mainly focused on the manner of reporting life-threatening and permanently disabling complications. The new grading system still mostly relies on the therapy used to treat the complication. The classification was tested in a cohort of 6336 patients who underwent elective general surgery at our institution. The reproducibility and personal judgment of the classification were evaluated through an international survey with 2 questionnaires sent to 10 surgical centers worldwide. The new ranking system significantly correlated with complexity of surgery (P < 0.0001) as well as with the length of the hospital stay (P < 0.0001). A total of 144 surgeons from 10 different centers around the world and at different levels of training returned the survey. Ninety percent of the case presentations were correctly graded. The classification was considered to be simple (92% of the respondents), reproducible (91%), logical (92%), useful (90%), and comprehensive (89%). The answers of both questionnaires were not dependent on the origin of the reply and the level of training of the surgeons. The new complication classification appears reliable and may represent a compelling tool for quality assessment in surgery in all parts of the world.
          Article 0 comments Cited 3326 times – based on 0 reviews     Review now
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            A risk model for esophagectomy using data of 5354 patients included in a Japanese nationwide web-based database.

            Hiroya Takeuchi, Hiroaki Miyata, MITSUKAZU GOTOH … (2014)
            This study aimed to create a risk model of mortality associated with esophagectomy using a Japanese nationwide database.
            Article 0 comments Cited 162 times – based on 0 reviews     Review now
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              The Impact of Severe Anastomotic Leak on Long-term Survival and Cancer Recurrence After Surgical Resection for Esophageal Malignancy.

              Sheraz Markar, Caroline Gronnier, Alain Duhamel … (2015)
              The aim of this study was to the determine impact of severe esophageal anastomotic leak (SEAL) upon long-term survival and locoregional cancer recurrence.
              Article 0 comments Cited 93 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Shigeru Tsunoda:
                ORCID: http://orcid.org/0000-0003-1468-7352
                tsunoda@kuhp.kyoto-u.ac.jp
                Journal
                Journal ID (nlm-ta): Surg Case Rep
                Journal ID (iso-abbrev): Surg Case Rep
                Title: Surgical Case Reports
                Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )
                ISSN (Electronic): 2198-7793
                Publication date (Electronic): 7 January 2022
                Publication date PMC-release: 7 January 2022
                Publication date Collection: December 2022
                Volume: 8
                Electronic Location Identifier: 5
                Affiliations
                [1 ]GRID grid.258799.8, ISNI 0000 0004 0372 2033, Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, , Kyoto University, ; 54 Shogoin- Kawahara-cho, Sakyo-ku, Kyoto, 606-8507 Japan
                [2 ]GRID grid.258799.8, ISNI 0000 0004 0372 2033, Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, , Kyoto University, ; 54 Shogoin- Kawahara-cho, Sakyo-ku, Kyoto, 606-8507 Japan
                Author information
                http://orcid.org/0000-0003-1468-7352
                Article
                Publisher ID: 1359
                DOI: 10.1186/s40792-022-01359-z
                PMC ID: 8738834
                PubMed ID: 34993694
                SO-VID: 246d90e5-6010-4bea-9fa3-b77e53e2d759
                Copyright © © The Author(s) 2022
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                Date received : 12 August 2021
                Date accepted : 4 January 2022
                Categories
                Subject: Case Report
                Custom metadata
                issue-copyright-statement © The Author(s) 2022

                Keywords: esophageal cancer,esophagectomy,celiac artery stenosis,median arcuate ligament,doppler ultrasonography
                Data availability:
                Keywords: esophageal cancer, esophagectomy, celiac artery stenosis, median arcuate ligament, doppler ultrasonography

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