Recurrence after ESD curative resection for early gastric cancer

Abstract

Background: Endoscopic submucosal dissection (ESD) is gaining ground as a minimally invasive treatment for early gastric cancer (EGC) that has a negligible risk of lymph node metastasis. According to the 5th edition of Japanese gastric cancer treatment guidelines, annual or biannual follow-up with endoscopy is recommended, but follow-up with abdominal ultrasonography or computed tomography (CT) for surveillance of metastases is not recommended after the eCuraA resection. However, we experienced a case of lymph node recurrence following ESD resulting in eCuraA.

Case presentation: A 76-year-old female received ESD for EGC in a previous hospital 4 years ago. Pathological findings were tub1, 30 mm, T1a (M), UL0, Ly0, V0, pHM-, pVM- (eCuraA) according to the 15th edition of Japanese Classification of Gastric Carcinoma. Follow-up esophagogastroduodenoscopy revealed submucosal tumor, which was suspected as a swollen lymph node by CT and endoscopic ultrasound fine-needle aspiration revealed the recurrence of gastric cancer. We performed total gastrectomy with D2 lymph node dissection. Postoperative pathological examination revealed no local recurrent tumor at the ESD site in the stomach. Swollen lymph node was diagnosed as metastasis and lymph node metastasis was limited near the cardia.

Conclusion: This case provides valuable information about tumor with a minimum poorly differentiated adenocarcinoma component may develop lymph node metastasis even satisfying the guidelines criteria for curative resection.

Keywords: Endoscopic submucosal dissection; Gastrectomy; Gastric cancer; Neoplasm metastasis; Recurrence.

Fig. 1

Preoperative findings. a, b EGD found ESD scar at the lesser curvature of antrum and a SMT at the lesser curvature of cardia. c CT shows an approximately 30-mm, high density, round mass at the lesser curvature of upper gastric body. d Uptake of fluorodeoxyglucose seen on PET–CT

Fig. 2

Pathological findings. a ESD specimen predominantly reveals a well to moderately differentiated adenocarcinoma with a poorly differentiated component which the blue lines indicate. The orange lines indicate the cancer. b The tumor measures 37 × 33 mm. c A lymph node resected by surgery reveals a moderately to poorly differentiated adenocarcinoma