Recurrence as a tumor deposit after endoscopic submucosal dissection of early rectal cancer

We found a 15 mm, 0-IIa + IIc polyp in the rectosigmoid with colonoscopy (CS), and performed endoscopic submucosal dissection (ESD) for it. The histopathologic specimen revealed that it was well-differentiated adenocarcinoma, T1b (SM2, 2000 μm), Ly0, v0, BD1, pHM0, and pVM0. Despite the non-curative resection with SM-deep invasion, the patient chose careful follow-up with contrast-enhanced computed tomography and CS. A nodule was first detected on the left side just out of the lower rectum 3 and a half years after ESD. Since it enlarged gradually, we judged that it was local recurrence in form of lymph-node metastasis and performed additional surgery 5 years after ESD. Pathological findings disclosed that the nodule was local recurrence as a tumor deposit (TD). One year after TD resection, lung metastasis was additionally founded and was resected surgically. If ESD accomplishes complete resection for T1b colorectal cancer and deep submucosal invasion is the only factor of non-curative resection, follow-up may be chosen instead of additional surgical resection. However, careful follow-up should be considered, because recurrence including TD may happen several years after ESD.