817. ARTERIA LUSORIA: IMPLICATIONS FOR ESOPHAGEAL SURGERY

Abstract Background The aberrant right subclavian artery, also known as arteria lusoria, is an embryologic abnormality affecting 0.5-1.8% of individuals. Instead of arising from the brachiocephalic artery, the right subclavian artery emerges as the fourth branch of the aortic arch. In most cases (80%), the artery has a retro-esophageal trajectory, while in 20% it runs anteriorly, which may pose difficulties in performing a safe intra-thoracic or cervical anastomosis. This condition is associated with a non-recurrent right inferior laryngeal nerve. Methods Following Kurokawa’s publication in 2019, our unit has adopted routine recurrent bilateral laryngeal nerve lymphadenectomy in esophageal and cardia carcinomas with over than 4 cm of esophageal involvement. We present a video that features a 68-year-old male diagnosed with a squamous cell carcinoma of lower thoracic esophagus, staged as cT3N+M0. He presents with a retro-esophageal arteria lusoria and non-recurrent right inferior laryngeal nerve. Following the CROSS protocol with neoadjuvant chemoradiotherapy, the patient underwent a Mckeown esophagectomy with total thoracic lymphadenectomy. Results In this presentation, we explore the anatomical details and surgical considerations associated with the arteria lusoria in esophageal surgery. This video details the essential procedural steps for the identification of the vagus nerve and the identification of the arteria lusoria during upper mediastinal dissection. This case emphases the need for customized surgical strategies and the role of interdisciplinary collaboration, particularly integration of radiological insights. Such cooperation ensures that the surgical team is ready to address the unique challenges presented by these anatomical deviations and minimize the risks. Conclusion In conclusion, this presentation aims to highlight the procedural intricacies and the collaborative effort required to manage effectively the arteria lusoria in esophageal surgery. https://drive.google.com/file/d/1agjPmA6lxPoVVPxvgJCHaDCqs1dJP-xk/view