Four Cases of Esophageal Cancer with Nonrecurrent Inferior Laryngeal Nerve -Anatomic Variant and Intraoperative Precaution-

Makoto Yamasaki, Yuichiro Doki, Hiroshi Miyata, Takushi Yasuda, Shuji Takiguchi, Yoshiyuki Fujiwara and Morito Monden

Department of Surgery and Clinical Oncology, Graduate School of Medicine, Osaka University

A nonrecurrent inferior laryngeal nerve (NRILN) is a rare anomaly. We report four cases of esophageal cancer with NRILN treated by transthoracic esophagectomy with three-field lymphadenectomy. All had been diagnosed as esophageal cancer. Under a diagnosis of concomitant NRILN based on preoperative computed tomography, we conducted transthoracic esophagectomy with three-field lymphadenectomy. The right subclavian artery on the right between the esophagus and vertebral column was recognizable perioperatively. The right recurrent nerve was not identified at the right subclavian artery during mediastinal dissection, but the NRILN was identified as going directly from the vagal nerve to the larynx during neck lymphadenectomy. The thoracic duct ran between the esophagus and the azygos vein, terminating at the right venous angle. Because the aberrant right subclavian artery is associated with the NRILN, right-sided terminating thoracic duct, etc., surgery must proceed under stringent controll with these abnormalities in mind. In patients with NRILN, cancer tends to metastasize to neck lymph nodes regardless of upper mediastinal lymph nodes, which is why esophagectomy with three-field lymphadenectomy is considered standard in treating thoracic esophageal cancer with NRILN.

Key words
nonrecurrent inferior laryngeal nerve, esophageal cancer, aberrant right subclavian artery

Reprint requests
Makoto Yamasaki Department of Surgery and Clinical Oncology Graduate School of Medicine, Osaka University
2-2 Yamadaoka, Suita, 565-0871 JAPAN

Accepted
January 31, 2007

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