We herein report a case of local recurrence of T1a rectal cancer following radical endoscopic mucosal resection (EMR). A 63-year-old man underwent EMR for a 0-IIa lesion of the Ra portion of the rectum. The findings on pathological examination were tub1, T1a (SM1, 420 µm), ly0 and v0, and the EMR had been considered a transitional procedure. Colonoscopy performed 26 months after EMR revealed a submucosal tumor (SMT) near the EMR scar in the left wall of the Ra portion of the rectum. An abdominal enhanced computed tomography scan revealed infiltration of the thickness of the wall with limited extramural extension, and a lymph node 10 mm in diameter. Endoscopic ultrasound-guided fine-needle aspiration also indicated a SMT on the left side of the Ra portion of the rectum that extended from the submucosal layer to beyond the serosal layer, and a lymph node sized 17×11 mm to the left of the Ra portion near the oral side 2 cm from the SMT. The pathological findings confirmed the SMT to be an adenocarcinoma with a metastatic lymph node. Local and lymph node recurrence of rectal cancer following radical EMR was diagnosed, and laparoscopic ultra-low anterior resection, D3 lymph node dissection and a diverting ileostomy were performed. The pathological findings of the excised specimen were T3 (A/SS), ly0, v3, PN1b, pPM0, pDM0, pRM0 (100 µm) and pN0 (0/15). XELOX therapy was administered for 6 months postoperatively as adjuvant chemotherapy, and there has been no recurrence during the first 12 months of follow-up.
Keywords: T1a rectal cancer; local recurrence; radical endoscopic mucosal resection.