[A case of elder gastric cancer patient who relapsed at the local stomach wall and the regional lymph node at the time of six months after endoscopic submucosal dissection (ESD)].

A case is a woman of 81-year-old. She was admitted to our hospital for a close examination of anemia from her family doctor. Gastroscopy revealed a 15 mm diameter of the type 0-IIa+IIc lesion at the posterior wall to the lesser curvature of the gastric body. And the biopsy of the lesion revealed a moderately differentiated adenocarcinoma (tub2). In consideration of the gastrectomy at this point, but firstly, an endoscopic submucosal dissection (ESD) was planned to perform for gaining the total pathological diagnosis of the lesion. Pathological findings revealed that the cancer cell invaded massively to submucosa (sm2), and that lymphatic permeation and venous permeation were also presented (ly2, v2). We explained it to the patient about the necessity of additional gastric resection, but she rejected the operation. So we had no choice but to observe the patient closely. Two months after the ESD, gastroscopy revealed no recurrent signs. But six months after the ESD, the local area of the stomach was revealed type 2 advanced gastric cancer, and computed tomography (CT) revealed a lymphoid swelling at the side of lesser curvature. We performed distal gastrectomy and D2 lymphoid dissection at this point. The final pathological diagnosis was T2 (ss) N2H0P0M0, Stage IIIA, based on the Japanese classification of gastric cancer. Adjuvant chemotherapy (oral fluoropylimidine) was interrupted in short period because of the side effects such as nausea, appetite loss, and diarrhea. There has been no recurrence for 1 year and six months since the operation. ESD is a minimally invasive technique and it is safe, convenient, and efficacious from the gastric functional point of view. However, the therapeutic strategies of the early gastric cancer, especially submucosally invasive gastric cancer, must be decided carefully and individually, considering the risk factors and the postoperative quality of life (QOL).