A rare clinical case of hepatic artery anatomy in a patient with Siewert III cardioesophageal junction cancer: A case report.

INTRODUCTION: The normal anatomy of the celiac trunk (CT) is characterized by splitting into three branches in approximately 80 % of cases. In other cases, multiple anatomical variations can be observed. The purpose of this study was to review the clinical case featuring an extremely rare location of common hepatic artery (CHA) and to emphasize the importance of being familiar with possible anatomical variations of the hepatic artery through preoperative imaging in preparation for oncological surgery. PRESENTATION OF CASE: A 71-year-old patient presented with Siewert III cardioesophageal junction cancer with liver metastases (T2N2M1, stage IV). Preoperative contrast-enhanced computed tomography (CECT) showed that the CHA branched from the AA. The operation included the proximal resection of the stomach and abdominal esophagus, D2 lymph nodes dissection, peritumoral liver resection, and extramucosal pyloroplasty. DISCUSSION: We report a rare anatomical variation of replaced common hepatic artery, when it is located as VI type of Hiatt's classification - CHA branching from abdominal aorta (AA). It was discovered during contrast-enhanced computed tomography and illustrated by 3D reconstruction of vascular architectonics of the celiac trunk. CONCLUSION: This case shows the importance of preoperative preparation using CECT to identify anatomical variations of the CHA, particularly for patients with locally advanced and metastatic cancer.

Video-assisted thoracoscopic surgery for prevention of postpneumonectomy syndrome: A case report.

INTRODUCTION: Postpneumonectomy syndrome is a pathological condition consisting in a persistent violation of the function of external respiration caused by the inflection of the trachea and/or the main bronchus and manifested by respiratory insufficiency. PRESENTATION OF CASE: The article describes a method of video-assisted thoracoscopic surgery for intraoperative prevention of the development of postpneumonectomy syndrome by installing a mesh implant in a patient with central cancer of the right lung. DISCUSSION: The range of alternatives that have been put forth for the treatment and prevention of the emergence of postpneumonectomy syndrome, on the one hand, demonstrates the relevance of the issue and, on the other, demonstrates the inadequate outcomes of the employed techniques. CONCLUSION: As a result of a mesh implant that is rigidly linked to the ribs, the preventative strategy we describe reliably prevents mediastinal displacement and doesn't necessitate repeated surgical intervention.

Gastric Conduit Cancer following Ivor-Lewis Esophagectomy for Esophageal Adenocarcinoma: A Case Report and Literature Review.

The incidence of gastric cancer associated with esophageal cancer is notably high. In recent years, there has been an increase in patients with gastric conduit cancers due to early detection and radical treatment of esophageal cancer, leading to prolonged survival of the patients. Metachronous gastric cancer following esophagectomy sometimes can pose a clinical challenge for surgeons, while gastric tube reconstruction is a well-established procedure accompanying esophagectomy, treating gastric cancer within the gastric tube can be difficult in contrast. Surgical treatment of gastric tube cancers is often complex and life-threatening. Early detection of gastric tube cancer is crucial for improving prognosis as it allows for less invasive surgical interventions. However, no specific guidelines for detecting gastric tube cancer have been established. In this report, we present a case of gastric tube cancer in a patient that had Ivor-Lewis surgery 20 years ago for preinvasive adenocarcinoma of the thoracic esophagus against the background of Barrett's esophagus. Recommendations for earlier and more accurate diagnosis and treatment of this pathology are discussed.

Simultaneous operations for gastric cancer and aortic aneurysm: a case report.

BACKGROUND: Gastric cancer is the second highest cause of morbidity among malignant tumors of the gastrointestinal tract and fifth in overall cancer statistics. Diseases of the cardiovascular system are the leading causes of death in the world. Aneurysm of the abdominal aorta is the most common type of vascular aneurysm, while in 75% of the cases it is asymptomatic. The risk of rupture of aneurysm of the abdominal aorta increases progressively depending on its diameter and the age of the patient. CASE PRESENTATION: A 56-year-old male patient underwent treatment for complaints of pain and discomfort in the epigastric region, general weakness and difficulty in passing food through the esophagus. The neoplasm extended to the esophagus up to 17-20 mm (pT3N3aM0 R0 stage IIIB TNM 8). The aortic diameter at the level of the renal arteries was 18 mm; lower than the main renal arteries, an expansion of up to 60 mm was visualized; the length of aneurysm was 105 mm extending to the bifurcation. A gastrectomy with a resection of the lower thoracic esophagus and application of a manual double-row Roux-en -Y esophagojejunal anastomosis with cholecystectomy and D2 lymphadenectomy was done along with longitudinal aneurysmectomy and thrombectomy. The proximal anastomosis between the aorta and the synthetic linear prosthesis of 18 × 9 × 9 mm in the end-to-end type was formed by a continuous winding suture with the "Prolene" 5-0 thread. The end-to-end distal anastomosis of the prosthesis and aorta branch was formed by continuous winding suture with the "Prolene" 6-0 thread. The postoperative period proceeded without features and complications. On the 7th day after the surgery, the patient was discharged home in satisfactory condition. CONCLUSIONS: Performing a simultaneous operation allowed the patient to undergo rehabilitation after the treatment of two diseases during one hospitalization and, in the shortest possible time, to proceed to the next stage of gastric cancer treatment-chemotherapy, thereby improving the prognosis of life expectancy. Also, one-stage surgical treatment of concomitant aneurysm of the abdominal aorta and gastric cancer is well tolerated and can avoid financial costs, and patient anxiety involved in a second operation.

Left thoracotomy approach for aortic root surgery.

Marfan syndrome is an autosomal dominant disease of connective tissue affecting approximately one in 5 000 people. However, the majority of patients (60-80%) with Marfan syndrome have some degree of aortic root dilation or thoracic aortic aneurysm that can lead to aortic dissection and rupture, which has long been recognised as the leading cause of death in Marfan syndrome. The funnel breast (pectus excavatum), often seen in patients with Marfan syndrome, radically complicates the access during aortic root or arch interventions, forcing cardiosurgery practitioners to seek alternative approaches. We present a series of clinical observations of two patients with Marfan syndrome and aneurysm of the aortic root and ascending aorta. A left-sided thoracotomy provides the possibility of successful implementation of extensive surgical interventions, decreasing the risks of intra-operative damage to the cardiac structures adjacent to the sternum in this complex cohort of patients.

The patient with megaesophagus due to long-term achalasia combined with squamous cell carcinoma: A case report.

INTRODUCTION: Achalasia is a rare disease of the esophagus accompanied by progressive development of symptoms such as dysphagia, vomiting, and chest pain, which in case of ineffective treatment leads to the formation of megaesophagus and requires radical surgical treatment. The relationship between the lengthy course of esophageal achalasia and the chance of developing esophageal cancer has been evidenced in the international literature. PRESENTATION OF CASE: This paper presents a case of a patient with long-term (30 years) achalasia, grade 4 dysphagia, and severe concomitant cardiovascular pathology who was diagnosed with megaesophagus and carcinoma of the lower thoracic esophagus after receiving solely symptomatic treatment. The patient underwent a video-assisted thoracoscopic K.C. McKeown esophagectomy, two-field lymphadenectomy, and esophageal gastroplasty. The postoperative period proceeded without complications. Ten months post-surgery there were no signs of recurrence or progression of the disease. The patient also noted a decrease in cardiac symptoms. DISCUSSION: Clinical manifestations of achalasia are characterized by progressive dysphagia, predominant nocturnal regurgitation, aspiration of undigested food, and weight loss. The role of cancer surveillance in achalasia remains controversial. Medical therapy and minimally invasive interventions can be used for both early and late stages of the disease. The use of minimally invasive techniques for the megaesophagus is recognized as ineffective and increases the risk of post-manipulation complications. CONCLUSION: Since minimally invasive techniques are ineffective, radical surgical treatment, or esophagectomy, appears to be the best choice in case of the development of megaesophagus and the detection of esophageal cancer.

Aortic arch aneurysm. Tracheobronchial compression as a vital indication for emergency surgery: A case report.

INTRODUCTION: Giant thoracic aortic aneurysms and aortic arch dissections are accompanied by high mortality rates, cardiac and neurologic events and pulmonary complications. Tracheobronchial compression with aorta-tracheal fistula is a rare complication of the aorta aneurysms. Aortic arch replacement in such case presents several formidable challenges. PRESENTATION OF CASE: This is the case report of successful surgical treatment of giant aortic arch aneurysm, complicated by airway compression, aorta-tracheal fistula and recurrent community-acquired pneumonia. DISCUSSION: Urgent indications for the aortic arch aneurysms surgery include significant size and high risk of rupture. As well as a visceral compression are presented. Bronchoscopy can be used to successfully treatment at all stages from trachea intubation to extubation. CONCLUSION: Aggressive surgical approach with careful pre-operative diagnostic are the key to success and the only one chance for patients with aortic arch aneurysm, complicated by airway compression.

Aortic homograft implantation after Ozaki procedure: Case report.

INTRODUCTION AND IMPORTANCE: The infective endocarditis incidence data for patients undergoing aortic valve neocuspidization with glutaraldehyde-treated autologous pericardium (Ozaki procedure) are rare, and the optimal surgical treatment strategy remains unclear. CASE PRESENTATION: This is the first case report of surgical treatment of infective endocarditis of aortic valve with cryopreserved homograft in an athlete with previously performed Ozaki procedure. CLINICAL DISCUSSION: The choice of homograft was dictated by the young age of the patient; professional activity as an athlete; refusal of anticoagulants and the need for wide excision of compromised tissues to mitigate potential risk of spread of infection as well as its recurrence. CONCLUSION: The use of the aortic homograft allowed us to radically remove the infected tissues and achieve hemodynamic characteristics similar to the native valve. This is probably the first case report of use of homograft to treat aortic valve endocarditis following Ozaki procedure.

Rare diseases of esophagus: Surgical treatment of cysts in adults. Case report.

INTRODUCTION AND IMPORTANCE: Esophageal cysts (EC) are congenital, extremely rare malformation. Up to 80% of EC are diagnosed in childhood, therefore, we can find only few clinical observations of EC in adults in literature. CASE PRESENTATION: During the period from October to December 2019, a successful surgical treatment of 2 patients (1 male and 1 female) with enterogenous and duplication cysts of esophagus was performed at the Clinic of Faculty Surgery at Sechenov University. In both cases thoracic tumors were incidental findings during routine health investigation. CLINICAL DISCUSSION: Clinical manifestations of ECs are caused by compression or displacement of the adjacent anatomical structures, therefore, most often patients complain of dysphagia, vomiting, pain in the chest, which may be constant or occur during an act of breathing. There are also observations of neurological symptoms due to compression of the radicular nerves The method of choice in the treatment of ECs is their surgical removal. CONCLUSION: Patients with mediastinal tumors should be treated in specialized hospitals by experienced surgeons who can cope with an unexpected intraoperative finding and carry out the appropriate surgery.

The First Case of Simultaneous Surgical Procedure for Mitral Valve Disease and Esophageal Cancer.

Cardiological patients with malignant tumors belong to a complex category of patients. We present the world's first case of simultaneous surgical treatment of severe mitral valve disease and esophageal cancer. The patient underwent simultaneous replacement of the mitral valve and the Ivor-Lewis procedure using right thoracotomy and upper midline laparotomy. The patient underwent 3 courses of chemotherapy (paclitaxel and 5-fluoroucil). Follow-up for 8 months showed no signs of tumor recurrence or cardiac problems. A dextral thoracotomy with the lung deprivation, supplemented by an upper median laparotomy, achieved us convenient access to the mitral valve and to all parts of the esophagus, including groups of compromised lymph nodes. This case demonstrates the modern possibilities of simultaneous cardio and oncosurgery that allows eliminating competitive fatal diseases in 1 surgical and anesthetic intervention.