ESD for a metachronous cancer after ESD. EndoTODAY 이준행

[Gastric cancer 844. ESD for a metachronous cancer after ESD]

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Metachronous cancer develops in 1-2%/year after ESD for EGC. Six years after ESD for EGC, a metachronous cancer was found in the lesser curvature aspect of the high body. ESD was done again.

[1st ESD (left)]
ESD: Early gastric carcinoma
1. Location : proximal antrum, greater curvature
2. Gross type : EGC type IIb+IIc
3. Histologic type : tubular adenocarcinoma, moderately differentiated
4. Histologic type by Lauren : intestinal
5. Size of carcinoma : (1) longest diameter, 14 mm (2) vertical diameter, 13 mm
6. Depth of invasion : invades mucosa (lamina propria) (pT1a)
7. Resection margin : free from carcinoma(N), safety margin : distal 11 mm, proximal 12 mm, anterior 18 mm, posterior 12 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: absent
[2nd ESD (right)]
ESD: Early gastric carcinoma
1. Location : high body, lesser curvature
2. Gross type : EGC type IIa+IIc
3. Histologic type : tubular adenocarcinoma, well differentiated
4. Histologic type by Lauren : intestinal
5. Size of carcinoma : (1) longest diameter, 18 mm (2) vertical diameter, 14 mm
6. Depth of invasion : invades mucosa (lamina propria) (pT1a)
7. Resection margin : free from carcinoma(N) safety margin : distal 7 mm, proximal 6 mm, anterior 12 mm, posterior 10 mm, deep 200 ㎛
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: absent

After ESD for EGC, I usually recommend to do the follow-up examination (EGD and CT) at local secondary hospitals. In this case, the metachronous cancer was found at a local secondary hospital. Thank you very much for the detailed examination.

의료전달체계의 유지는 매우 중요한 이슈입니다. 중증 급성기 병원에서는 급한 치료를 하고 follow up은 집근처 1-2차 의료기관에서 시행하는 것이 우리나라의 전체적인 의료시스템 효율화를 위하여 꼭 필요한 일입니다. ESD 후 환자에게 내시경과 CT가 가능한 집근처 2차 의료기관으로 되의뢰 가실 것을 권하고 있으나 실제로 되의뢰 되는 환자는 절반의 절반 정도 밖에 되지 않습니다. 안타까운 현실입니다.