Esophageal cancer resection and right aortic arch: successful approach through left thoracotomy

Esophagectomy is usually performed through a right thoracotomy because of t he left position of the aortic arch. We report four cases of right-sided ao rtic arches in patients admitted for esophageal carcinoma. Two cases were i ncluded in total situs inversus syndrome and were thus diagnosed before eso phageal carcinoma diagnosis. In these cases, the standard surgical techniqu e was modified in a mirror image fashion and was thus performed through a l eft thoracotomy. The two other cases were of isolated right aortic arch and were discovered during preoperative evaluation of the esophageal carcinoma . Such asymptomatic anatomical variations have to be recognized ba the esop hageal surgeon because of the possible association of heart malformation an d risk of: iatrogenic aortotracheal or aortoesophageal fistula during trach eal or esophageal endoscopy, biopsy or intubation. Usually, esophageal rese ction and anastomosis are impossible through a right thoracotomy and left t horacotomy is required.