Gastric cancer. EndoTODAY

[Gastric cancer 805. Local recurrence after ESD for EGC]

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ESD for EGC was recommened by a surgeon. The margin of the lesion was not discrete, but the forceps biopsy showed "tubular adenocarcinoma, moderately differentiated (WHYX lesion)". ESD was done.

ESD: Early gastric carcinoma
1. Location : antrum, greater curvature
2. Gross type : EGC type IIc
3. Histologic type : tubular adenocarcinoma, moderately differentiated > poorly differentiated (30 %)
4. Histologic type by Lauren : mixed
5. Size of carcinoma : (1) longest diameter, 38 mm (2) vertical diameter, 30 mm
6. Depth of invasion : invades mucosa (muscularis mucosa) (pT1a)
7. Resection margin : free from carcinoma(N) but very close to proximal margin, safety margin : distal 4 mm, proximal less than 1 mm, anterior 2 mm, posterior 18 mm
8. Lymphatic invasion : not identified(N)
9. Venous invasion : not identified(N)
10. Perineural invasion : not identified(N)
11. Microscopic ulcer : absent
12. Histologic heterogeneity: present

The ESD pathology showed multiple risk factors of recurrence (size larger than 3 cm, mixed type histology with 30% of poorly differentiated component, negative resectiona margin but very close). I explained to the patient that there is no definite reason for surgey right now but the chance of recurrence is higher than usual, so careful follow-up is recommended.

Six years after the ESD, local recurrence was found. I recommended surgery.

Stomach, radical subtotal gastrectomy: Early gastric carcinoma
1. Location : middle third, Center at angle and greater curvature
2. Gross type : EGC type IIb
3. Histologic type : tubular adenocarcinoma, moderately differentiated
4. Histologic type by Lauren : intestinal
5. Size : 1.5x0.6 cm
6. Depth of invasion : invades mucosa (lamina propria) (pT1a)
7. Resection margin: free from carcinoma, safety margin: proximal 5.0 cm, distal 3.7 cm
8. Lymph node metastasis : no metastasis in 41 regional lymph nodes (pN0)
9. Lymphatic invasion : not identified
10. Venous invasion : not identified
11. Perineural invasion : not identified
12. AJCC stage by 8th edition: pT1a N0

Careful follow-up is a very important part of endoscopic treatment of early gastric cancer.

* Reference: EndoTODAY local recurrence after ESD for EGC