Esophagus anatomy

Esophagus Anatomy questions from Superspeciality exams

Q1.  Which is not included in Two field esophagectomy in carcinoma esophagus

a) Supra carinal and cervical

b) Infra carinal and celiac

c) Superior mediastinal

d) Posterior mediastinal


Q2. Blood supply of esophagus are all except  (AIIMS 2012) 

a) Inferior thyroid A

b) Middle thyroid A

c) Tracheobronchial A

d) Bronchoesophageal A


Q3. Narrowest part  of esophagus

a) Cricopharyngeus

b) Aortic arch

c) Tracheal bifurcation

d) Gastroesophageal junction


Q4) False about esophagus Vascular sharing

a) Cervical- majorly from Inferior thyroid artery and also from Superior thyroid artery

b) Abdominal – majorly from LGA and also from Inferior phrenic artery

c) Upper thoracic- inferior thyroid artery and also Subclavian

d)Lower thoracic- majorly from Intercostal A and also from Aorta

Answer


Answer 1. a) Supra carinal and cervical

Ide et al. classification:

Standard 2-field dissection 2 S below carina

 Extended 2-field  dissection 2F -  total mediastinal lymph node dissection upto apex of chest

3-field resections  . In 3F resection bilateral cervical lymph node dissection is performed. All types of resections imply abdominal D2 lymph node dissection as in gastrectomy.

Divisions of esophagus

The cervical esophagus from lower border of the cricoid cartilage to thoracic inlet (the suprasternal notch), about 18 cm from the upper incisor

The intrathoracic esophagus

 (a) the upper thoracic portion from the thoracic inlet toe tracheal bifurcation, 24 cm from the upper incisor

(b) the midthoracic portion  between the tracheal bifurcation and the distal esophagus just at the esophagogastric junction ( 32 cm from the upper incisor teeth)

(c) the lower thoracic portion 8 cm in length includes the intraabdominal portion of the esophagus and the esophagogastric junction. The latter is about 40 cm from the upper incisor teeth.

Lymph node drainage of  esophagus 

  1. Japanese system 1976  (developed from stomach cancer staging) 
  2. Western system 1994    (developed from lung cancer staging)

Japanese system Lymph nodes 

                                                         Stations 1-16 as for stomach cancer   

Cervical and mediastinal were given numbers from 100-112

 Stations were divided into N1 to N 4 according to distance from primary tumor

Right recurrent laryngeal nerve (CRLN) node- Watershed between mediastinum and cervical along the right recurrent laryngeal nerve, behind the right subclavian artery and between the trachea and the esophagus at the supreme portion of the thorax. 

 

 

 

 

 

European system

The stations that were modified to the special needs of esophageal cancer

3P (posterior) for upper paraesophageal lymph nodes above the tracheal bifurcation,

station 8, which was divided into 8M (middle) and 8L (lower) paraesophageal lymph nodes.

Stations 15 through 20 were added to the map and designated the diaphragmatic and abdominal lymph nodes

 

 


2. b Middle thyroid artery

Supply of esophagus in neck is  superior and inferior thyroid arteries

At the level of aortic arch - Tracheobronchial arteries and sometimes large bronchial artery

Cardiac end - Left gastric a. , slenic artery

Bronchoesophageal artery has bronchial artery branches and esophageal artery branches

Ref Shackelford page 23


3. a

Cricopharyngeus

Length of esophagus is 25 cm

Esophagus extends from lower border of cricoid (c6) to side of T11 vertebra

It has three constrictions:

a) at 15 cm narrowest- cricopharyngeus

b) at 23 cm from incisior whrere it croses the aortic arch

c) at 40 cm at the GE junction

No reference. it is given everywhere


4) c Upper thoracic is not from subclavian but from tracheobronchial and bronchoesophgeal arteries

Blood supply esophagus