title: Recurrent advanced colonic cancer occurring 11 years after initial endoscopic piecemeal resection: a case report.
abstract: BACKGROUND
  The high frequency of local recurrence occurring after endoscopic piecemeal resection (EPMR) for large colorectal tumors is a serious problem. However, almost all of these cases of local recurrence can be detected within 1 year and cured by additional endoscopic resection. We report a rare case of recurrent advanced colonic cancer diagnosed 11 years after initial EPMR treatment.
  
  
  METHODS
  A 65-year-old male was diagnosed with a sigmoid colon lesion following a routine health check-up. Total colonoscopy revealed a 12 mm type 0-Is lesion in the sigmoid colon, which was diagnosed as an adenoma or intramucosal cancer and treated by EPMR in 1996. The post-resection defect was closed completely using metallic endoclips to avoid delayed bleeding. In 2007, at the third follow up, colonoscopy revealed a 20 mm submucosal tumor (SMT) like recurrence at the site of the previous EPMR. The recurrent lesion was treated by laparoscopic assisted sigmoidectomy with lymph node dissection.
  
  
  CONCLUSIONS
  When it is difficult to evaluate the depth and margins of resected tumors following EPMR, it is important that the defect is not closed in order to avoid tumor implantation, missing residual lesions and to enable earlier detection of recurrence. It is crucial that the optimal follow-up protocol for EPMR cases is clarified, particularly how often and for how long they should be followed.
authors.affiliation: Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Kishino
authors.forename: Takahisa
authors.initials: T
authors.lastname: Matsuda
authors.forename: Taku
authors.initials: T
authors.lastname: Sakamoto
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nakajima
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Taniguchi
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Yamamoto
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Saito
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000601:surgery*; D000368:Aged; D003110:Colonic Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D004724:Endoscopy / Q000379:methods*; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000601:surgery; D013997:Time Factors