Distant or lymph nodes recurrence after endoscopic submucosal dissection for superficial esophageal cancer

Background: Endoscopic submucosal dissection (ESD) has become a standard treatment for superfi cial esophageal cancer (SEC) in Japan, and the adaptation of ESD for SEC has been expanding. Although we sometimes experience some recurrent cases after ESD, there are few reports about distant recurrence after ESD. Methods: The aim of this study is to clarify details of distant or lymph node recurrence after ESD and their clinical courses. Among 258 patients who underwent ESD for SEC from January 2003 to December 2010 in our institute, distant or lymph node recurrence occurred in seven patients. We investigated their clinicopathological features, results of ESD and details of recurrence and clinical course. Results: The clinicopathological features and the details of ESD were as follows; median age: 75 (55-83)yrs, location (Ut/Mt/Lt/Ae): 1/2/3/1, median tumor size: 44 (28-59)mm, en bloc resection:six cases, pathological tumor depth (MM/SM1/SM2): 2/2/3, positive lymphovascular invasion: 2 cases (pMM, SM2). Additional therapies were performed on fi ve cases (surgery: 1 (pSM1), chemoradiotherapy(CRT): 2 (pMM, pSM2), chemotherapy(CT): 1 (pSM1), radiotherapy(RT): 1 (pSM2), observation: 2 (pMM, pSM2)). The median period from ESD to recurrence was 22 (4.4-44)months. The sites of recurrence were mediastinal lymph node: 4 (pMM/pSM2:2/2), cervical lymph node: 1 (pSM1), paraaortic lymph node: 1 (SM1) and pulmonary metastasis with mediastinal lymph node: 1 (pSM2). The details of treatment after recurrence were surgery: 1 (pMM), neck dissection: 1 (pSM1), CRT: 1 (pSM1), CT: 1 (pMM), RT: 1 (pSM2) and best supportive care: 2 (pSM2). Five patients died because of esophageal cancer.. Discussion: Although the number of recurrent cases was small, we found recurrence on cases with additional treatments after ESD. Careful observation after ESD is considered to be necessary in presence or absence of additional therapy.