Lymph Node Recurrence after Endoscopic Resection of Early Gastric Cancer Previously Classified as eCura B

A 63-year-old woman underwent endoscopic submucosal dissection for early gastric cancer. The lesion initially met the former eCura B criteria but was reclassified as eCura A under the updated Japanese guidelines, which do not recommend routine imaging follow-up. Nineteen months after curative resection, a solitary swollen lymph node was detected on computed tomography and metastasis was histopathologically confirmed. After chemotherapy, the patient underwent a total gastrectomy without residual carcinoma. While such recurrence is rare, this case suggests that clinicians should remain aware of the possibility of lymph node metastasis, even in lesions considered curative under the current criteria.