[A Case of Pathological Complete Response of Colon Cancer after Systemic Chemotherapy with mFOLFOX6].

Neoadjuvant chemoradiotherapy is a standard mode of therapy for rectal cancer but not colon cancer. A 74-year-old man undergoing treatment for prostate cancer was found to have a tumor in both the sigmoid colon and liver. Colonoscopy showed a type 2 tumor of the sigmoid colon, with a biopsy confirming a diagnosis of well differentiated tubular adenocarcinoma. Computed tomography demonstrated a tumor of the sigmoid colon with metastasis to the liver. As there was a high suspicion of invasion of the left ureter, we decided to administer mFOLFOX6 as neoadjuvant chemotherapy prior to tumor resection. After 8 courses of mFOLFOX6, both the primary lesion and liver metastasis significantly decreased in size. Subsequently, the patient underwent a sigmoidectomy and partial hepatectomy. Histopathological examination revealed pathological complete response(Grade 3). It is important to reveal effective cases of neoadjuvant chemotherapy, the appropriate treatment regime and timing of surgical intervention so as to advance therapeutic strategies for the treatment of colon cancer.

[A case of cardiopulmonary arrest due to hypersensitivity reaction to oxaliplatin for multiple liver and lung metastases of colon cancer].

A 69-year-old man underwent right hemicolectomy and D3 lymphadenectomy for transverse colon cancer in 2009. Under the postoperative pathological diagnosis of Stage IIIb (pT3pN2cM0) cancer, he was given 8 courses of adjuvant chemotherapy with capecitabine. After the chemotherapy, in April 2013, we detected recurrence of the multiple liver and lung metastases; thus, we administered modified 5-fluorouracil, Leucovorin, oxaliplatin (mFOLFOX6) and bevacizumab. Six courses of oxaliplatin infusion were completed uneventfully. However, 3 min after starting the seventh infusion courses, the patient experienced cardiopulmonary arrest. We immediately performed cardiopulmonary resuscitation. The patient's anaphylaxis symptoms resolved after treatment with intravenous epinephrine. He was discharged 3 days after the event with no further complications. Clinicians should be aware that oxaliplatin-induced anaphylactic shock often occurs during the eighth infusion cycle and that this severe hypersensitivity reaction is difficult to predict and prevent.

[A case of recurrent gastric cancer effectively treated by combined chemotherapy of weekly paclitaxel (PTX) and CDDP].

The patient was a 63-year-old man who underwent distal gastrectomy for advanced gastric cancer with lymph node metastasis and peritoneal dissemination. One year and eleven months after the operation,an increasing CA 19-9 concentration and metastases to the liver and peritoneum were observed. Oral TS-1 was given, but had to be discontinued because of anorexia and nausea. Chemotherapy consisting of paclitaxel (PTX) and CDDP was performed. PTX (80 mg/body) was administered weekly on day 1, 8 and 15, while CDDP (50 mg/body) was administered weekly on day 1 as one cycle. After two cycles of PTX/CDDP administration,metastases to the liver and peritoneum were not detected. The patient was treated with five courses of PTX/CDDP and survived without recurrence as of this writing. PTX/CDDP was associated with few adverse events in hospital visits, and thought to be an effective chemotherapy against recurrent gastric cancer.

Motor and electrogastrographic activity of the gastric tube formed after esophagectomy.

In order to characterize the motor activity of a surgically constructed gastric tube, several hours of ambulatory intraluminal pressure recordings were performed in 6 patients following esophagectomy and gastric tube construction. Whole pressure waves were spectrally analyzed by Fast Fourier Transform (FFT). Simultaneous abdominal and thoracic electrogastrograms (EGGs) were recorded for about 20 min both before and after meals during ambulatory pressure recording. The pressure waves and EGGs for each 20 min recording were analyzed by the maximal entropy method (MEM). While the motility index of the pressure waves decreased after a meal, the 3 cpm component of these waves (2.4-3.7 cpm) increased significantly (n=6, P<0.05). Both bradygastria (0-2.4 cpm) and the duodeno-respiratory component (10-15 cpm) decreased, while the tachygastria component (3.7-10 cpm) increased, although these differences were not significant. The peak power of the gastric tube abdominal EGGs was significantly larger than that of control abdominal or thoracic EGGs in each of the 1 cpm (0-2.4 cpm), 6 cpm (5.0-7.4) and 8 cpm components (7.5-9.9). The thoracic EGG consisted mainly of the 3 cpm component, while the spectral amplitudes of the 1, 6, 8 and 10 cpm components were below 6% of the 3 cpm component. The peak spectral frequency both of the intraluminal pressure waves by FFT and of the thoracic EGGs by MEM occurred within the 3 cpm component. A cross correlation of about 0.2-0.3 occurred between the thoracic EGGs and the intraluminal pressure waves. Thus the gastric tube seems to preserve most of the original gastric motor characteristics and to contribute as a substitute for the original esophagus and stomach.

Spectral analysis of colonic intraluminal pressure in patients who received a colonic replacement following radical esophagectomy.

The aim of this study was to evaluate the motor activity of the interposed colonic segment in patients who had received a colonic replacement following radical esophagectomy using spectral analysis and a 24 hr activity graph. The 24-hr ambulatory pressure waves were recorded in the replaced colon after esophagectomy (n=8) using a solid-state manometric catheter (MicroDigitrapper, Synetics). Motility and spectral analyses of the intraluminal pressure waves were performed by Multigram and Gastrosoft (Synetics). It was revealed that after a meal the 3 cpm (cycles per minute) component of the motility index increased but the 12-15 cpm component decreased. The diurnal rhythm showed that colonic motility was high in the daytime and low during sleep. In contrast, duodenal motility was relatively high even during sleep. The motility index increased as the postoperative period increased. The motility of the replaced colon was higher during the daytime and after meals. The higher motility after meals was characterized by an increase in the 3 cpm component. These motor characteristics may help the function of the replaced colon as a substitute for the esophagus.

Electrogastrographic activity in patients who received proximal gastrectomy plus jejunal interposition or total gastrectomy plus jejunal interposition.

Electrogastrograms (EGGs) were recorded in patients both before and after receiving proximal gastrectomy plus jejunal interposition (PGJI) or just after receiving total gastrectomy plus jejunal interposition (TGJI). Intraluminal pressure was also recorded in some postoperative patients. The EGG 3 cpm component (2.5-4.9 cpm) remained after PGJI, but subsequently decreased with a significant reduction in the preoperative to postoperative ratio of the 3 cpm components (P<0.05). The mean frequency of the 3 cpm components increased significantly after PGJI (P<0.05) and its instability factor increased. The EGG 10 cpm components became relatively dominant compared to other frequency components in 2 out of 8 of patients having PGJI but the mean amplitude of 10 cpm decreased. In TGJI patients, only the 10 cpm component was conspicuous in EGG as in the case of total gastrectomy and Roux en Y anastomosis procedures. The spectral frequencies of intraluminal pressure in the interposed jejunum were similar to the EGG of 10 cpm components both in the case of PGJI and TGJI patients. In conclusion, surface EGG could record the electrical activities of the interposed jejunum more easily in patients having had TGJI than in PGJI.

Topographical electrogastrograms after radical esophagectomy with colonic replacement.

PURPOSE: To characterize the functional substitution of colon for the esophagus, we compared the electrogastrogram (EGG) maps and spectral frequencies and power of preoperative controls with patients who had undergone colonic replacement. METHODS: Monopolar EGGs were recorded and spectrally analyzed at 27 locations on the thoracoabdominal surface. The spectral powers of five frequency groups were converted into EGG maps. RESULTS: In contrast to the epigastric concentrations of maximal power foci in a preoperative 3-cpm (cycles per minute) group, those of the colon replacement subjects seemed not to be concentrated in the epigastric region. Power in the 6-cpm colon replacement group were significantly greater and those in the 3-cpm colon replacement group were significantly less than those in the preoperative controls. Spectral frequencies in the 1- and 3-cpm colon replacement groups were significantly higher than those in the preoperative controls. CONCLUSIONS: The colonic and gastric EGG activities had 3-cpm, and probably 6-cpm in common. However, the colonic EGG activities were significantly different from the gastric EGG activities in frequency in the 3-cpm group, and in amplitude in both the 3- and 6-cpm groups. Thus, the replaced colon seems to preserve the original colonic EGG activity.