Figure 6a. Transthoracic esophagectomy with a left thoracoabdominal approach in a 66-year-old man with double primary cancer of the left lung and the lower esophagus. (a) Preoperative CT scan (5-mm section thickness) obtained at the level of the right inferior pulmonary vein shows an esophageal mass (arrow) and a 3-cm mass in the lingular segment of the upper lobe of the left lung (arrowhead). (b) Fluorodeoxyglucose (FDG) positron emission tomographic (PET) scan shows two separate hypermetabolic lesions, one in the lower esophagus (standardized uptake value [SUV] = 11.2) and one in the left upper lobe (SUV = 14.3). (c) Barium esophagogram obtained 2 months after surgery shows an intrathoracic anastomosis with focal narrowing (arrow), a finding that suggests an anastomotic stricture. Arrowheads indicate the surgical clips used for lymph node dissection of the lung cancer.