Hirose Kosuke, Sadanaga Noriaki, Kato Seiya, Yoshimura Daisuke, Sokabe Yuta, Sasaki Shun, Honbo Takuya, Tsuda Yasuo, Matsuura Hiroshi, Mimori Koshi
Department of Surgery, Kyushu University Beppu Hospital, Tsurumibara 4546, Beppu-Shi, Oita, 874-0838, Japan.
Department of Surgery, Saiseikai Fukuoka General Hospital, Tenjin 1-3-46, Chuo-Ku, Fukuoka-Shi, Fukuoka, 810-0001, Japan.
Clin J Gastroenterol. 2025 Aug 21. doi: 10.1007/s12328-025-02206-y.
Esophageal squamous cell carcinoma confined to the depth of the T1a-epithelium and lamina propria mucosa rarely exhibits lymph node and distant organ metastases; therefore, the recommended therapy for such cases is endoscopic resection. Furthermore, once esophageal squamous cell carcinoma recurs after curative treatment, including endoscopic mucosal dissection, a unified treatment method cannot be established, because recurrence patterns vary from case to case. Herein, we present an unusual case of metachronous locoregional and subclavian lymph-node recurrence following repeated radical endoscopic submucosal dissection of the superficial esophageal squamous cell carcinoma judged as T1a-LPM with deep subepithelial stromal invasion. The patient was treated using a multidisciplinary approach, leading to a cancer-free status. Although recurrent lymph-node metastasis after curative endoscopic submucosal dissection for pT1a-LPM esophageal squamous cell carcinoma is rare, it is possible. A comprehensive and detailed analysis of the risk factors of recurrence after endoscopic resection for pT1a-LPM cases is required, and appropriate follow-up strategies and stratified adjuvant therapies should be selected for high-risk patients.
局限于T1a期上皮层和黏膜固有层的食管鳞状细胞癌很少出现淋巴结和远处器官转移；因此，此类病例推荐的治疗方法是内镜下切除。此外，包括内镜黏膜下剥离术在内的根治性治疗后，一旦食管鳞状细胞癌复发，由于复发模式因病例而异，无法确立统一的治疗方法。在此，我们报告一例不同时间发生的局部区域和锁骨下淋巴结复发的罕见病例，该病例为经多次根治性内镜黏膜下剥离术治疗的浅表食管鳞状细胞癌，最初判定为T1a-LPM（黏膜固有层）伴深层上皮下间质浸润。该患者采用多学科方法进行治疗，最终实现无癌状态。尽管pT1a-LPM期食管鳞状细胞癌经根治性内镜黏膜下剥离术后出现复发性淋巴结转移的情况罕见，但仍有可能发生。对于pT1a-LPM病例，需要对内镜切除术后复发的危险因素进行全面、详细的分析，并应为高危患者选择合适的随访策略和分层辅助治疗。
