FOLFOXIRI (fluorouracil, leucovorin, oxaliplatin, and irinotecan) plus bevacizumab is the preferred first-line treatment for right-sided metastatic colorectal cancer with RAS mutation. However, severe adverse events are common in Japanese patients. We report the successful management of multiple stage IV colorectal cancers in a patient who received multidisciplinary treatment, including chemotherapy and Japanese Kampo medicine. A 68-year-old man presented with epigastralgia and appetite loss and was diagnosed with multiple stage IV colorectal cancers. Colonoscopy identified type II tumors in the ascending colon, sigmoid colon, and upper rectum. Histopathological examination of a biopsy specimen revealed well- to moderately differentiated tubular adenocarcinoma. Enhanced computed tomography of the thorax and abdomen showed multiple pulmonary nodules and para-aortic lymph node swelling. Laparoscopic loop-ileostomy was performed to avoid bowel obstruction due to severe stenosis of ascending colon cancer. Intraoperative observation revealed two white nodules suggestive of metastasis in the lateral area of the liver. Therefore, we diagnosed multiple stage IV colorectal cancers with multiple metastases (lung, liver, and distant lymph nodes). His postoperative course was uneventful, and chemotherapy was started. Since the cancer cells harbored a RAS mutation, he received FOLFOXIRI plus bevacizumab. Japanese Kampo medicine consisting of Hangeshashinto and Juzen-taiho-to, to prevent diarrhea and fatigue, was administered daily. After 12 courses of chemotherapy, though circumferential stenosis still existed in the ascending colon, the tumors in the sigmoid colon and upper rectum were unclear. Enhanced computed tomography showed shrinkage of the pulmonary nodules and para-aortic lymph node; therefore, laparoscopic-assisted ileocecal resection was performed. The postoperative histopathological examination revealed moderately differentiated adenocarcinoma. The patient recovered uneventfully, and Kampo medicine consisting of Ninjin'yoeito was administered for postoperative weakness. Administration of adjuvant chemotherapy in this patient led to a near complete response that has been maintained without recurrence for 2 years and 8 months without reduced quality of life.

FOLFOXIRI（氟尿嘧啶、亚叶酸、奥沙利铂和伊立替康）加贝伐单抗是右侧转移性结直肠癌 RAS 突变的首选一线治疗方法。然而，严重的不良事件在日本患者中很常见。我们报告了一名接受多学科治疗（包括化疗和日本汉方药）的患者的多发性 IV 期结直肠癌的成功治疗。一名 68 岁男性因上腹痛和食欲减退就诊，并被诊断出患有多发性 IV 期结直肠癌。结肠镜检查在升结肠、乙状结肠和上直肠中发现了 II 型肿瘤。活检标本的组织病理学检查显示分化良好至中度的管状腺癌。胸部和腹部的增强计算机断层扫描显示多个肺结节和主动脉旁淋巴结肿胀。进行腹腔镜袢回肠造口术以避免因升结肠癌严重狭窄引起的肠梗阻。术中观察发现两个白色结节提示肝脏外侧区域有转移。因此，我们诊断出具有多处转移（肺、肝和远处淋巴结）的多发性 IV 期结直肠癌。他的术后病程平安无事，开始了化疗。由于癌细胞含有 RAS 突变，他接受了 FOLFOXIRI 加贝伐珠单抗治疗。日本汉方药由 Hangeshashinto 和 Juzen-taiho-to 组成，用于预防腹泻和疲劳，每天服用。经过12个疗程的化疗，虽然升结肠仍存在环状狭窄，但乙状结肠和直肠上段肿瘤尚不清楚。增强型计算机断层扫描显示肺结节和主动脉旁淋巴结缩小；因此，进行了腹腔镜辅助回盲部切除术。术后组织病理学检查显示为中分化腺癌。患者恢复得很顺利，术后虚弱的情况下，服用了含有忍精若依土的汉方药。该患者接受辅助化疗后，几乎完全缓解，并保持 2 年零 8 个月无复发，生活质量没有降低。增强型计算机断层扫描显示肺结节和主动脉旁淋巴结缩小；因此，进行了腹腔镜辅助回盲部切除术。术后组织病理学检查显示为中分化腺癌。患者恢复得很顺利，术后虚弱的情况下，服用了含有忍精若依土的汉方药。该患者接受辅助化疗后，几乎完全缓解，并保持 2 年零 8 个月无复发，生活质量没有降低。增强型计算机断层扫描显示肺结节和主动脉旁淋巴结缩小；因此，进行了腹腔镜辅助回盲部切除术。术后组织病理学检查显示为中分化腺癌。患者恢复得很顺利，术后虚弱的情况下，服用了含有忍精若依土的汉方药。该患者接受辅助化疗后，几乎完全缓解，并保持 2 年零 8 个月无复发，生活质量没有降低。并为术后虚弱服用了由忍者如英组成的汉方药。该患者接受辅助化疗后，几乎完全缓解，并保持 2 年零 8 个月无复发，生活质量没有降低。并为术后虚弱服用了由忍者如英组成的汉方药。该患者接受辅助化疗后，几乎完全缓解，并保持 2 年零 8 个月无复发，生活质量没有降低。