TWO CASES OF ENDOSCOPIC CURABILITY C-2 EARLY GASTRIC CANCER WITH METASTATIC RECURRENCE DURING POST-ESD SURVEILLANCE SUCCESSFULLY TREATED BY SALVAGE SURGERY

Abstract

Case 1 involved a 78-year-old man with superficial flat and protruding early gastric cancer (55mm) located on the lesser curvature of the middle gastric body. Case 2 was an 84-year-old man with superficial elevated and protruding early gastric cancer (27mm) located on the posterior wall of the middle gastric body. Both patients underwent ESD, resulting in negative margins during resection. However, because of deep submucosal and positive lymphovascular invasion, endoscopic curability C-2 (eCuraC-2) was diagnosed. In both cases, follow-up observations were performed as consent for additional surgeries could not be obtained. During routine follow-up, computed tomography revealed lymph node enlargement at 31 and 37 months post-ESD in cases 1 and 2, respectively, prompting salvage surgical resection. Histopathologically, lymph node metastasis was confirmed at station 3a for case 1 and stations 3a and 9 for case 2. Notably, both patients remained free of gastric cancer-related mortality after salvage surgery. Metastatic recurrence following non-curative ESD for early gastric cancer without additional surgery manifests as distant metastasis, rendering curative treatment extremely rare. These two cases highlight the potential for successful salvage surgery in patients with regional lymph node recurrence confirmed by careful surveillance after noncurative ESD.