Surgical treatment of dysphagia lusoria caused by an aberrant right subclavian artery: a case report and literature review
Introduction
Dysphagia lusoria refers to dysphagia caused by an aberrant right subclavian artery (ARSA), a rare congenital anomaly of the aortic arch. This article presents a clinical case of symptomatic ARSA, accompanied by a comprehensive review of its anatomical, clinical, and therapeutic aspects.
Material and methods
We present the case of a 54-year-old female patient diagnosed with dysphagia lusoria due to ARSA, who underwent surgical intervention after clinical and imaging evaluations. The literature was reviewed through PubMed using the keywords: “aberrant right subclavian artery”, “dysphagia lusoria”, and “arteria lusoria”.
Results
The patient presented with progressive dysphagia, morning cough, fatigue, and weight loss. Imaging revealed ARSA compressing the esophagus, and the presence of a bicarotid trunk. Surgical correction involved right subclavian-to-carotid transposition, with complete resolution of symptoms. The literature review showed a modest grade of evidence regarding the management of patients with dysphagia lusoria, mostly including case reports and limited case series. Treatment is usually indicated in symptomatic patients, with options including open surgery or hybrid approaches.
Conclusions
ARSA can cause significant esophageal symptoms in adults, representing a diagnostic challenge. Appropriate imaging and timely surgical intervention are crucial in symptomatic cases. Awareness of aortic anatomical variants is essential for both diagnosis and treatment planning.
Outcome analysis of the traditional therapeutic approach in patients with bronchopulmonary cancer and advanced anesthetic-surgical risk
Background
Lung cancer exhibits high global incidence and mortality rates. Surgical resection remains crucial to diagnosis, staging, and treatment of non-small cell lung cancer (NSCLC). However, advanced stages often require multimodal approaches. Prehabilitation, innovative perioperative techniques, and the exploration of immunotherapy hold promise for improving outcomes.
Materials and methods
This two-phase observational cohort study included a retrospective arm (100 patients, traditional treatment) and a prospective arm (100 patients, innovative perioperative management, and risk stratification). Descriptive and inferential statistics were used to evaluate data, identify risk factors, and compare the 2-year survival between treatment groups.
Results
Despite advances, lung cancer prognosis remains poor, with limited cure rates. Mean survival in the traditional approach was 1.3 years with a 5-year survival of only 1%. While prehabilitation and innovative techniques showed potential, no statistically significant differences in survival times were observed between the treatment groups. Patients with stage III (Charlson score 0-4) and stage I-II (Charlson score 5-12) demonstrated comparable outcomes, highlighting the importance of comorbidity burden.
Conclusions
Targeted screening protocols are of paramount importance for early detection and intervention. Population-wide smoking cessation programs, environmental protection measures, and the promotion of healthy lifestyles are vital for prevention and reducing incidence. Standard chemotherapy and radiotherapy offer limited therapeutic benefits in advanced lung cancer. This highlights a pressing need for breakthroughs in basic research to develop novel treatment paradigms that significantly improve outcomes. While this study did not reveal statistically significant survival differences between traditional and innovative perioperative approaches, prehabilitation and optimization techniques hold promise and deserve further research. The development of anti-tumor immunotherapy offers a significant potential in non-surgical lung cancer treatment, especially given the limitations in advanced-stage disease management. Harnessing the immune system to fight cancer represents a promising new frontier.