Necessity of preoperative imaging of the gastro-epiploic arcade prior to esophageal resection.

Vascularization of the gastric tube is essential for healing of the esophagogastric anastomosis after resection and reconstruction in patients with esophageal cancer. Leakage of the anastomosis is significantly associated with perioperative mortality. Knowledge of the vascular anatomy before gastric tube construction is of great importance in patients with previous surgery and potential division of the right gastro-epiploic vessels. 3D-computed tomographic angiography is effective for assessing the suitability of the gastro-epiploic arcade prior to esophagectomy by obtaining a road map of the graft's blood supply, as demonstrated in a 72-year-old patient with adenocarcinoma of the distal esophagus and previous extended right hemicolectomy for colon cancer.