| Theme |
Metastatic recurrence and prognosis after endoscopic treatment for early colorectal carcinoma |
| Title |
A case of rectal T1b cancer developing lymph node, and distant metastases after endoscopic resection |
| Author |
Hiroyoshi Iwagami |
Department of Gastrointestinal Endoscopy, Osaka International Cancer Institute |
| Author |
Yoji Takeuchi |
Department of Gastrointestinal Endoscopy, Osaka International Cancer Institute |
| Author |
Noriko Matsuura |
Department of Gastrointestinal Endoscopy, Osaka International Cancer Institute |
| Author |
Satoki Shichijo |
Department of Gastrointestinal Endoscopy, Osaka International Cancer Institute |
| Author |
Akira Maekawa |
Department of Gastrointestinal Endoscopy, Osaka International Cancer Institute |
| Author |
Takashi Kanesaka |
Department of Gastrointestinal Endoscopy, Osaka International Cancer Institute |
| Author |
Koji Higashino |
Department of Gastrointestinal Endoscopy, Osaka International Cancer Institute |
| Author |
Noriya Uedo |
Department of Gastrointestinal Endoscopy, Osaka International Cancer Institute |
| Author |
Ryu Ishihara |
Department of Gastrointestinal Endoscopy, Osaka International Cancer Institute |
| [ Summary ] |
An 80-year-old man was presented with a 60 mm, nodular-mixed granular type laterally spreading tumor in his rectosigmoid colon. Magnifying-narrow band imaging indicated JNET (The Japan NBI Expert Team) Type 2B. The lesion was resected en bloc with endoscopic submucosal dissection. Pathological findings showed a small component of adenocarcinoma in a large adenoma. The cancer invaded to the submucosal layer and the depth was measured 6 mm from the surface of the tumor to the deepest part. Both lympho-vascular invasion and the vertical margin were negative. The patient refused additional rectal resection with lymph node dissection because of his age. Positron emission tomography 13 months after endoscopic resection showed swollen pararectal lymph nodes, a large mass in the right lobe of the liver and multiple nodules in his bilateral lung. Although it is reported that the advantage of additional surgical resection with lymph node dissection is low in the patient with deeply invaded submucosal colorectal cancer without other risk factors for lymph node metastasis, it is necessary to explain the possible risk of future metastasis when they are followed up without additional surgery. |