Liver metastatic recurrence after curative endoscopic submucosal dissection for slightly submucosal invasive gastric cancer: A case report and literature review

In Japan, differentiated-type early gastric cancer with submucosal invasion <500 µm, tumor diameter <3 cm, no lymphovascular invasion, and negative resection margin are included in pathological curative criteria after endoscopic resection (ER). However, there are a few reports presenting local or metastatic recurrence after ER for the lesions described above. A 72-year-old man was diagnosed with early gastric cancer and underwent endoscopic submucosal dissection (ESD). Pathological diagnosis was well-differentiated tubular adenocarcinoma, 8 × 6 mm, T1b1(SM1; 428 µm below the muscularis mucosae), negative lymphovascular invasion, and negative resection margin, which was included in curative criteria. Eighteen months after ESD, the laboratory studies indicated an increase in carcinoembryonic antigen of 17.6 ng/mL (normal range <5 ng/mL). While endoscopy showed no local recurrence finding, contrast-enhanced computed tomography (CT) showed a metastatic liver tumor in S4. Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging and ¹⁸F-fluorodeoxyglucose positron emission tomography/CT revealed metastatic liver tumors in S4, S5, and S8. The liver biopsy specimen showed tubular adenocarcinoma and the findings of immunochemical staining were similar to that of the specimen of prior ESD. Thus, he was diagnosed with multiple liver metastatic recurrences after curative ER. Currently, it has been 3 years and 5 months since ESD and 1 year and 11 months since liver metastatic recurrence, and the patient has survived receiving 5th-line systemic chemotherapy. Here, we report a rare case of liver metastatic recurrence 18 months after curative ESD for early gastric cancer.