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.

Regional lymph node recurrence without intragastric lesions after curative endoscopic resection of early gastric cancer meeting the absolute indications of endoscopic resection

“…There have been no reported instances of regional lymph node recurrence in the absence of intragastric lesions after curative endoscopic resection in patients meeting the absolute indications, such as the case in this report. However, the case with the closest similarity was that by Kamiya et al, [ 7 ] which presented with extragastric recurrence without intragastric lesions, after curative endoscopic resection of well-differentiated intramucosal early gastric cancer having a size of 30 mm without evidence of ulceration and lymphovascular invasion. The findings of this case are consistent with the findings of Lee et al [ 6 ] who reported 3 cases of regional lymph node recurrence without intragastric lesions from among 1302 patients who underwent curative resection under the expanded indications for endoscopic resection.…”

“…[ 4 , 5 ] Extragastric recurrence in the absence of intragastric lesions has been reported in the past for cases that met the criteria of the expanded indications of endoscopic resection. [ 6 , 7 ]…”

“…[4,5] Extragastric recurrence in the absence of intragastric lesions has been reported in the past for cases that met the criteria of the expanded indications of endoscopic resection. [6,7] In this case report, we present a case of extragastric regional lymph node recurrence without intragastric lesions in a patient who had undergone a curative endoscopic resection, having met the criteria of the absolute indications of endoscopic resection.…”

A pilot study of micro-CT-based whole tissue imaging (WTI) on endoscopic submucosal dissection (ESD) specimens

“…In fact, cases of lymph node metastasis recurrence despite the diagnosis of R0 resection of intramucosal carcinoma after ESD has been reported. This suggests that submucosal invasion existed in the section where H&E slides were not made 16 , 17 . WTI and WBI with micro-CT scans can observe findings that cannot be confirmed by conventional pathology slides and may lead to a more accurate diagnosis.…”

Predictive efficacy of combined tumor markers and gastrin for recurrence after endoscopic submucosal dissection in early gastric cancer patients

“…Consequently, many global gastric cancer treatment guidelines recommend endoscopic surgery as the preferred treatment strategy for early gastric cancer. However, despite the effectiveness of ESD, its associated high rate of heterochronic recurrence needs to be addressed [6]. Studies have shown that recurrence usually occurs near the original tumor site, highlighting the need to assess and predict possible risk factors for recurrence [7][8][9].…”