Background Neoadjuvant chemoradiation therapy (nCRT) has become the standard of care for esophageal cancer patients prior to esophagectomy. However, the optimal timing for surgery after completion of nCRT remains unclear. Methods A retrospective review was performed of patients who underwent esophagectomy with cervical anastomosis for esophageal cancer at a single institution between January 2000 and June 2015. Patients were categorized into 3 cohorts: those who did not receive nCRT prior to esophagectomy (no nCRT), those who underwent esophagectomy within 35 days after nCRT (≤35d), and those who underwent esophagectomy more than 35 days after nCRT (>35d). Results A total of 366 esophagectomies were performed during the study period, and 348 patients met the inclusion criteria. Anastomotic leaks occurred in 11.8% of all patients included in the study (41 of 348). Within each cohort, anastomotic leaks were detected in 14.7% of patients (17 of 116) in the no nCRT cohort, 7.3% (13 of 177) in the ≤35d cohort, and 20.0% (11 of 55) in the >35d cohort (p=0.020). Significant differences in the occurrence of anastomotic leaks were observed between the no nCRT and ≤35d cohorts (p=0.044), and between the ≤35d and >35d cohorts (p=0.007). Conclusion Esophagectomy with cervical anastomosis within 35 days of nCRT resulted in a lower percentage of anastomotic leaks.

We demonstrated safety and efficiency of a multispecialty approach for achalasia with POEM with a low rate of complications.

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Objective:Diagnostic/therapeutic accidents Background:Pseudopropionibacterium propionicum was called Propionibacterium propionicum until a recent taxonomy change in 2016. Diseases caused by P. propionicum resemble actinomycosis and thus differ dramatically from the infectious syndromes caused by common cutaneous Propionibacterium spp. However, if treating physicians are not familiar with P. propionicum and its clinical presentations, it is possible for them to regard it as a skin contaminant such as Cutibacterium acnes (formerly Propionibacterium acnes). Case Report:A 71-year-old man with past surgical history of right pneumonectomy was admitted with right chest wall abscess and right empyema. The chest wall abscess was drained surgically, and the empyema was drained via a chest tube. The abscess culture took 5 days to grow beaded branching Gram-positive rods, and 15 days to identify them as P. propionicum. The patient received 17 days of ceftriaxone and 4 weeks of doxycycline. However, he experienced a relapse of the chest wall abscess and right empyema 4 months after discontinuation of doxycycline. Cultures from the chest wall abscess and empyema grew P. propionicum again. We treated him with ceftriaxone for 6 months followed by minocycline for 7 months along with adequate drainage. Conclusions:It is important to recognize that P. propionicum can cause thoracic actinomycosis and will likely require the prolonged treatment course typical for actinomycotic disease, which is 2 to 8 weeks of intravenous antibiotic therapy followed by 6 to 12 months of oral antibiotic therapy.

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