Local Recurrence of EGC after ESD

Lee, Sang Hun; Jung, Jin Hwan; Song, Jun Ho; Kim, Jeong Ho; Cheung, Dae Young; Kim, Jin Il; Park, Soo Heon; Kim, Jae Kwang

Abstract

Endoscopic mucosal resection is not accepted as an alternative to surgery for treating EGC of the undifferentiated histologic type because of the relatively higher probability of lymph node metastasis with the endoscopic procedure. The recently developed endoscopic submucosal dissection (ESD) techniques have made en-bloc resection of large intramucosal or ulcerated lesions feasible, but the procedure's therapeutic indications are limited to EGC without lymph node metastasis. If we could define a subgroup of patients who have undifferentiated EGC with a low-risk of lymph node metastasis, then the application of ESD would be possible instead of surgery. ESD also allows precise histologic assessment of resected specimens and it may prevent residual disease and local recurrence. We report on a case that poorly differentiated adenocarcinoma was curatively removed by ESD, but cancer recurrence was detected in the lamina propria of the post ESD scar without lymph node metastasis or intraluminal lesions three years after the ESD.