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Lymph node metastasis after endoscopic submucosal dissection of a differentiated gastric cancer confined to the mucosa with an ulcer smaller than 30 mm
Author(s) -
Fujii Hiroyuki,
Ishii Eiji,
Tochitani Shinako,
Nakaji So,
Hirata Nobuto,
Kusanagi Hiroshi,
Narita Makoto
Publication year - 2015
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/den.12261
Subject(s) - medicine , endoscopic submucosal dissection , lymph node metastasis , gastric mucosa , cancer , lymph node , dissection (medical) , lymph , metastasis , pathology , gastroenterology , radiology , stomach
In the expanded indications for endoscopic resection, J apanese guidelines for gastric cancer include differentiated cancers confined to the mucosa with an ulcer <30 mm. We describe a patient with lymph node metastasis after curative endoscopic submucosal dissection ( ESD ) for a tumor of this indication. The patient was a 70‐year‐old man with chronic hepatitis C . He underwent ESD for early gastric cancer in M ay 2010. Pathology revealed a moderately differentiated adenocarcinoma, 22 × 17 mm in size, that was confined to the mucosa with an ulcer. The horizontal and vertical margins were negative for the tumor. We diagnosed thiscase as curative resection of expanded indication and followed this patient with endoscopy, abdominal ultrasonography ( AUS ) or enhanced computed tomography ( CT ) approximately every 6 months. After 17 months, lymph node metastasis was detected with AUS and CT and diagnosed by endoscopic ultrasound‐guided fine‐needle aspiration biopsy in A ugust 2011. Distal gastrectomy with D 2 dissection was carried out in D ecember 2011. Although it is low, the possibility of recurrence should be borne in mind after endoscopic treatment of early gastric cancer, despite its inclusion in the expanded indications for endoscopic resection.