Early Start of Chemotherapy after Resection of Primary Colon Cancer with Synchronous Multiple Liver Metastases: A Case Report

The start of chemotherapy treatment usually requires a delay of about 4 weeks after surgical resection in patients with primary colorectal cancer and synchronous distant metastasis. However, there is no evidence to indicate the required length of this delay interval. In addition, there is a chance that a patient may die because postoperative chemotherapy was not started soon enough and a metastatic tumor was able to develop rapidly. Here, we present a case in which combination chemotherapy with capecitabine and oxaliplatin (XELOX) was started within 1 week after a right hemicolectomy for synchronous multiple liver metastases. To our knowledge, this is the first report of the start of chemotherapy, involving treatments such as folinic acid, fluorouracil, and oxaliplatin (FOLFOX); folinic acid, fluorouracil, and irinotecan (FOLFIRI); and XELOX, within 1 week after a colorectal cancer operation with anastomosis. The findings suggest possible changes in the start time of chemotherapy after surgery in the future

Video Supporting_file_01[1]

Video for CA was defined as positive when all of the following three criteria were met upon observation of the LES performed with the attached ST Hood short-type: a) Congestion inside the hood, b) ischemic change around the hood, and c) palisade vessels outside the hood

Data from: New endoscopic finding of esophageal achalasia with ST Hood short type: corona appearance

Background and Study Aims: Detecting esophageal achalasia remains a challenge. We describe the diagnostic utility of corona appearance, a novel endoscopic finding specific to esophageal achalasia. Patients and Methods: Corona appearance and seven conventional endoscopic findings were compared for sensitivity and consistency (-value) among 53 untreated esophageal achalasia patients who underwent endoscopy at our hospital. The following criteria had to be met during lower esophageal sphincter examination using the attached ST Hood short-type for positive corona appearance: A) congestion inside the hood, B) ischemic change around the hood, and C) palisade vessels outside the hood. Results: Corona appearance had the highest sensitivity (91%; -value, 0.71). Other findings in descending order of sensitivity included 1) functional stenosis of the esophagogastric junction (EGJ; 86%; -value, 0.58), 2) mucosal thickening and whitish change (71%; -value, 0.27), 3) abnormal contraction of the esophageal body (59%; -value, 0.32), 4) dilation of the esophageal lumen (58%; -value, 0.53), 5) liquid remnant (57%; -value, 0.51), 6) Wrapping around EGJ (49%; -value, 0.14), and 7) food remnant (30%; -value, 0.88). Even in 22 patients with poor (grade 1) intraluminal expansion, corona appearance had highest sensitivity (88%) compared to other endoscopic findings (-value, 0.63). Conclusions: Among endoscopic findings using a ST Hood short-type to diagnose esophageal achalasia, corona appearance had the highest sensitivity and its consistency (-value) among endoscopists was substantial compared to other endoscopic findings. Similar results were obtained for esophageal achalasia cases with poor expansion. Endoscopic diagnosis of esophageal achalasia with hood attached is useful

New endoscopic finding of esophageal achalasia with ST Hood short type: Corona appearance - Fig 2

<p>CA was defined as positive when all of the following three criteria were met upon observation of the LES performed with the attached ST Hood short-type: a) Congestion inside the hood, b) ischemic change around the hood, and c) palisade vessels outside the hood.</p

Endoscopic findings in esophageal achalasia.

<p>a: Functional stenosis of the esophagogastric junction. b: Wrapping around the esophagogastric junction. c: Abnormal contraction of the esophageal body. d: Mucosal thickening and whitish change. e: Dilation of the esophageal lumen. f, g: Liquid and/or food remnant.</p

Corona of the sun.

<p>Source of photo: Nisshoku no subete, chasing shadows, an observer’s guide to solar eclipses, Osamu Ohgoe, Kazuo Shiota, Seibundo Shinkosha Publishing Co., Ltd. Quoted by the permission of Seibundo Shinkosha Publishing Co., Ltd. and Kazuo Shiota provided permission to republish this image under the Creative Commons Attribution (CC BY) 4.0 license.</p

General clinical features of patients with achalasia.

<p>General clinical features of patients with achalasia.</p

General sensitivity and κ-value of endoscopic findings in achalasia.

<p>General sensitivity and κ-value of endoscopic findings in achalasia.</p