Repeated lymph-node recurrences after radical endoscopic submucosal dissection in a patient of esophageal squamous cell carcinoma, judged as pT1a-LPM: a case report and literature review.

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.