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1. Comparison of Postoperative Complications After Gastrectomy for Gastric Cancer with Antecolic Versus Retrocolic Reconstruction: A Population-Based Study

Author

Junttila, Anna, Helminen, Olli, Helmiö, Mika, Huhta, Heikki, Jalkanen, Aapo, Kallio, Raija, Koivukangas, Vesa, Kokkola, Arto, Laine, Simo, Lietzen, Elina, Louhimo, Johanna, Meriläinen, Sanna, Pohjanen, Vesa-Matti, Rantanen, Tuomo, Ristimäki, Ari, Räsänen, Jari V., Saarnio, Juha, Sihvo, Eero, Toikkanen, Vesa, Tyrväinen, Tuula, Valtola, Antti, and Kauppila, Joonas H.

Published
2024
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2. Postoperative Complications After Neoadjuvant Chemotherapy Versus Upfront Surgery in Gastric Adenocarcinoma: A Population-Based Nationwide Study in Finland

Author

Putila, Emilia, Helminen, Olli, Helmiö, Mika, Huhta, Heikki, Jalkanen, Aapo, Kallio, Raija, Koivukangas, Vesa, Kokkola, Arto, Laine, Simo, Lietzen, Elina, Louhimo, Johanna, Meriläinen, Sanna, Pohjanen, Vesa-Matti, Rantanen, Tuomo, Junttila, Anna, Ristimäki, Ari, Räsänen, Jari V., Saarnio, Juha, Sihvo, Eero, Toikkanen, Vesa, Tyrväinen, Tuula, Valtola, Antti, and Kauppila, Joonas H.

Published
2024
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3. ASO Visual Abstract: Postoperative Complications After Neoadjuvant Chemotherapy Compared with Upfront Surgery in Gastric Adenocarcinoma—A Population-Based, Nationwide Study in Finland

Author

Putila, Emilia, Helminen, Olli, Helmiö, Mika, Huhta, Heikki, Jalkanen, Aapo, Kallio, Raija, Koivukangas, Vesa, Kokkola, Arto, Laine, Simo, Lietzen, Elina, Louhimo, Johanna, Meriläinen, Sanna, Pohjanen, Vesa-Matti, Rantanen, Tuomo, Junttila, Anna, Ristimäki, Ari, Räsänen, Jari V., Saarnio, Juha, Sihvo, Eero, Toikkanen, Vesa, Tyrväinen, Tuula, Valtola, Antti, and Kauppila, Joonas H.

Published
2024
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4. Impact of splenectomy on long-term outcomes after gastrectomy for gastric cancer: a population-based study

Author

Junttila, Anna, Helminen, Olli, Helmiö, Mika, Huhta, Heikki, Jalkanen, Aapo, Kallio, Raija, Koivukangas, Vesa, Kokkola, Arto, Laine, Simo, Lietzen, Elina, Louhimo, Johanna, Meriläinen, Sanna, Pohjanen, Vesa-Matti, Rantanen, Tuomo, Ristimäki, Ari, Räsänen, Jari V., Saarnio, Juha, Sihvo, Eero, Toikkanen, Vesa, Tyrväinen, Tuula, Valtola, Antti, and Kauppila, Joonas H.

Published
2024
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5. Postoperative delayed emptying after total, subtotal, or distal gastrectomy for gastric cancer: a population-based study

Author

Junttila, Anna, Helminen, Olli, Helmiö, Mika, Huhta, Heikki, Jalkanen, Aapo, Kallio, Raija, Koivukangas, Vesa, Kokkola, Arto, Laine, Simo, Lietzen, Elina, Louhimo, Johanna, Meriläinen, Sanna, Pohjanen, Vesa-Matti, Rantanen, Tuomo, Ristimäki, Ari, Räsänen, Jari V., Saarnio, Juha, Sihvo, Eero, Toikkanen, Vesa, Tyrväinen, Tuula, Valtola, Antti, and Kauppila, Joonas H.

Published
2024
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6. Stapled vs handsewn anastomosis and anastomotic leaks in gastric cancer surgery—a population-based nationwide study in Finland

Author

Kvist, Elina, Helminen, Olli, Helmiö, Mika, Huhta, Heikki, Jalkanen, Aapo, Junttila, Anna, Kallio, Raija, Koivukangas, Vesa, Kokkola, Arto, Laine, Simo, Lietzen, Elina, Louhimo, Johanna, Meriläinen, Sanna, Pohjanen, Vesa-Matti, Rantanen, Tuomo, Ristimäki, Ari, Räsänen, Jari V., Saarnio, Juha, Sihvo, Eero, Toikkanen, Vesa, Tyrväinen, Tuula, Valtola, Antti, and Kauppila, Joonas H.

Published
2024
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7. Preoperative Esophageal Stenting and 5-Year Survival in Patients Undergoing Esophagectomy for Esophageal Cancer: a Population-Based Nationwide Study from Finland

Author

Helminen, Olli, Sihvo, Eero, Helmiö, Mika, Huhta, Heikki, Kallio, Raija, Koivukangas, Vesa, Kokkola, Arto, Laine, Simo, Lietzen, Elina, Meriläinen, Sanna, Pohjanen, Vesa-Matti, Rantanen, Tuomo, Ristimäki, Ari, Räsänen, Jari V., Saarnio, Juha, Toikkanen, Vesa, Tyrväinen, Tuula, Valtola, Antti, and Kauppila, Joonas H.

Published
2023
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8. Long-Term Survival After Transhiatal Versus Transthoracic Esophagectomy: A Population-Based Nationwide Study in Finland

Author

Junttila, Anna, Helminen, Olli, Helmiö, Mika, Huhta, Heikki, Kallio, Raija, Koivukangas, Vesa, Kokkola, Arto, Laine, Simo, Lietzen, Elina, Meriläinen, Sanna, Pohjanen, Vesa-Matti, Rantanen, Tuomo, Ristimäki, Ari, Räsänen, Jari V., Saarnio, Juha, Sihvo, Eero, Toikkanen, Vesa, Tyrväinen, Tuula, Valtola, Antti, and Kauppila, Joonas H.

Published
2022
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9. Five-year Survival after McKeown Compared to Ivor-Lewis Esophagectomy for Esophageal Cancer: A Population-based Nationwide Study in Finland

Author

Junttila, Anna, Helminen, Olli, Helmio[Combining Diaeresis], Mika, Huhta, Heikki, Kallio, Raija, Koivukangas, Vesa, Kokkola, Arto, Laine, Simo, Lietzen, Elina, Merila[Combining Diaeresis]inen, Sanna, Pohjanen, Vesa-Matti, Rantanen, Tuomo, Ristimäki, Ari, Räsänen, Jari V., Saarnio, Juha, Sihvo, Eero, Toikkanen, Vesa, Tyrva[Combining Diaeresis]inen, Tuula, Valtola, Antti, and Kauppila, Joonas H.

Published
2023
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11. Preoperative hemoglobin count and prognosis of esophageal cancer, a population-based nationwide study in Finland

Author

Helminen, Olli, Helmiö, Mika, Huhta, Heikki, Kallio, Raija, Koivukangas, Vesa, Kokkola, Arto, Laine, Simo, Lietzen, Elina, Meriläinen, Sanna, Ohtonen, Pasi, Pohjanen, Vesa-Matti, Rantanen, Tuomo, Ristimäki, Ari, Räsänen, Jari V., Saarnio, Juha, Sihvo, Eero, Toikkanen, Vesa, Tyrväinen, Tuula, Valtola, Antti, Jokela, Ella M.K., and Kauppila, Joonas H.

Published
2022
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12. Impact of an appendicolith and its characteristics on the severity of acute appendicitis.

Author

Sula, Sami, Paananen, Timo, Tammilehto, Ville, Hurme, Saija, Mattila, Anne, Rantanen, Tuomo, Rautio, Tero, Pinta, Tarja, Sippola, Suvi, Haijanen, Jussi M, and Salminen, Paulina

Abstract

Background Antibiotics have been reported as an efficient and safe treatment option for uncomplicated acute appendicitis without an appendicolith diagnosed using computed tomography (CT). The aim of this study was to assess the association of a CT-diagnosed appendicolith and its characteristics with appendicitis severity. Methods A large prospective patient cohort with suspected acute appendicitis enrolled between April 2017 and November 2018 was retrospectively reviewed. The initial analysis evaluated the association of a CT-diagnosed appendicolith with complicated acute appendicitis; then, based on the availability of CT images, a subset of patients was analysed for the correlation of appendicolith characteristics with appendicitis severity. The final appendicitis assessment (uncomplicated or complicated—including perforation, gangrene, an abscess, or a tumour) was determined for all patients. Results Out of 3512 eligible patients, 3085 patients with appendicitis were selected and 380 patients with an appendicolith and with a CT image available for reassessment were included. Out of the 3085 patients with CT-diagnosed acute appendicitis, 1101 (35.7%) patients presented with both acute appendicitis and an appendicolith and, out of these, 519 (47.1%) had complicated acute appendicitis. In the patients without an appendicolith (1984 patients), 426 (21.5%) had complicated appendicitis (P < 0.001). Re-evaluation of CT images for 380 patients showed that a larger appendicolith diameter (OR = 1.15 (95% c.i. 1.06 to 1.25); P < 0.001), appendicolith location at the base of the appendix (55.1% versus 44.9%; P = 0.008), and heterogeneous appendiceal wall enhancement around the appendicolith (68.4% versus 31.6%; P < 0.001) were associated with an increased risk of complicated acute appendicitis. Conclusion The presence of an appendicolith in patients with acute appendicitis is correlated with the risk of complicated appendicitis. This risk is further increased by a larger appendicolith diameter or appendicolith location at the base of the appendix. [ABSTRACT FROM AUTHOR]

Published
2024
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14. Three-Year Outcomes of Oral Antibiotics vs Intravenous and Oral Antibiotics for Uncomplicated Acute Appendicitis

Author

Selänne, Liisa, primary, Haijanen, Jussi, additional, Sippola, Suvi, additional, Hurme, Saija, additional, Rautio, Tero, additional, Nordström, Pia, additional, Rantanen, Tuomo, additional, Pinta, Tarja, additional, Ilves, Imre, additional, Mattila, Anne, additional, Rintala, Jukka, additional, Marttila, Harri, additional, Meriläinen, Sanna, additional, Laukkarinen, Johanna, additional, Sävelä, Eeva-Liisa, additional, Paajanen, Hannu, additional, Grönroos, Juha, additional, and Salminen, Paulina, additional

Published
2024
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15. Stapled versus hand-sewn anastomosis and anastomotic leaks in gastric cancer surgery – a population-based nationwide study in Finland

Author

Kvist, Elina, primary, Helminen, Olli, additional, Helmiö, Mika, additional, Huhta, Heikki, additional, Jalkanen, Aapo, additional, Kallio, Raija, additional, Koivukangas, Vesa, additional, Kokkola, Arto, additional, Laine, Simo, additional, Lietzen, Elina, additional, Louhimo, Johanna, additional, Meriläinen, Sanna, additional, Pohjanen, Vesa-Matti, additional, Rantanen, Tuomo, additional, Ristimäki, Ari, additional, Räsänen, Jari V., additional, Saarnio, Juha, additional, Sihvo, Eero, additional, Toikkanen, Vesa, additional, Tyrväinen, Tuula, additional, Valtola, Antti, additional, and Kauppila, Joonas H., additional

Published
2024
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16. ASO Visual Abstract: Long-Term Survival after Transhiatal Compared with Transthoracic Esophagectomy—a Population-Based Nationwide Study in Finland

Author

Junttila, Anna, Helminen, Olli, Helmiö, Mika, Huhta, Heikki, Kallio, Raija, Koivukangas, Vesa, Kokkola, Arto, Laine, Simo, Lietzen, Elina, Meriläinen, Sanna, Pohjanen, Vesa-Matti, Rantanen, Tuomo, Ristimäki, Ari, Räsänen, Jari V., Saarnio, Juha, Sihvo, Eero, Toikkanen, Vesa, Tyrväinen, Tuula, Valtola, Antti, and Kauppila, Joonas H.

Published
2022
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19. Population-based nationwide incidence of complications after gastrectomy for gastric adenocarcinoma in Finland

Author

Putila, Emilia, primary, Helminen, Olli, additional, Helmiö, Mika, additional, Huhta, Heikki, additional, Jalkanen, Aapo, additional, Kallio, Raija, additional, Koivukangas, Vesa, additional, Kokkola, Arto, additional, Laine, Simo, additional, Lietzen, Elina, additional, Louhimo, Johanna, additional, Meriläinen, Sanna, additional, Pohjanen, Vesa-Matti, additional, Rantanen, Tuomo, additional, Ristimäki, Ari, additional, Räsänen, Jari V, additional, Saarnio, Juha, additional, Sihvo, Eero, additional, Toikkanen, Vesa, additional, Tyrväinen, Tuula, additional, Valtola, Antti, additional, and Kauppila, Joonas H, additional

Published
2023
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23. Wait-and-see strategy is justified after ERCP and endoscopic sphincterotomy in elderly patients with common biliary duct stones

Author

Kivivuori, Antti, Mattila, Laura, Siiki, Antti, Laukkarinen, Johanna, Rantanen, Tuomo, and Ukkonen, Mika

Subjects
Surgery, Critical Care and Intensive Care Medicine
Abstract

Older patients with simultaneous main bile duct and gallbladder stones, especially those with high-surgical risks, create a common clinical dilemma. After successful endoscopic removal of main bile duct stones, should these patients undergo laparoscopic cholecystectomy to reduce risk of recurrent biliary events?In this population-based cohort study, we report long-term outcomes of a wait-and-see strategy after successful endoscopic extraction of main bile duct stones.Consecutive patients aged ≥75 years undergoing endoscopic stone extraction without subsequent cholecystectomy in two tertiary academic centers between January 2010 and December 2018 were included. Primary outcome measure was recurrence of biliary events. Secondary outcome measures were operation-related morbidity and mortality.A total of 450 patients (median age 85 years, 61% female) were included, with a median follow-up time of 36 (0-120) months. Recurrent biliary events occurred in 51 patients (11%), with a median time from index hospital admission to recurrence of 307 (12-1993) days. The most biliary event common was acute cholecystitis (7.1%). Twelve patients had cholangitis (2.7%) and two biliary pancreatitis (0.4%). Only one patient (0.4%) underwent surgery due to later gallstone-related symptoms. Eighteen patients (4.0%) required endoscopic intervention and 16 (3.5%) underwent surgery. There were no operation-associated deaths or morbidity among those undergoing later surgical or endoscopic interventions.In elderly patients, it is relatively safe to leave gallbladder in situ after successful sphincterotomy and endoscopic common bile duct stone removal. In elderly and frail patients a wait-and see strategy without routine cholecystectomy rarely leads to clinically significant consequences.Study type: therapeutic/care management.Level III, Therapeutic study.

Published
2022

28. Preoperative Esophageal Stenting and 5-Year Survival in Patients Undergoing Esophagectomy for Esophageal Cancer : a Population-Based Nationwide Study from Finland

Author

on behalf of the FINEGO group, Helminen, Olli, Sihvo, Eero, Helmiö, Mika, Huhta, Heikki, Kallio, Raija, Koivukangas, Vesa, Kokkola, Arto, Laine, Simo, Lietzen, Elina, Meriläinen, Sanna, Pohjanen, Vesa Matti, Rantanen, Tuomo, Ristimäki, Ari, Räsänen, Jari V., Saarnio, Juha, Toikkanen, Vesa, Tyrväinen, Tuula, Valtola, Antti, Kauppila, Joonas H., Tampere University, TAYS Heart Centre, and Department of Gastroenterology

Subjects
3126 Surgery, anesthesiology, intensive care, radiology
Abstract

Background: Preoperative esophageal stenting is proposed to have a negative effect on outcomes. The aim was to compare a 5-year survival in patients undergoing esophagectomy for esophageal cancer with and without preoperative esophageal stent in a population-based nationwide cohort from Finland. The secondary outcome was 90-day mortality. Methods: This study included curatively intended esophagectomies for esophageal cancer in Finland between 1999 and 2016, with follow-up until December 31, 2019. Cox proportional hazards models provided hazard ratios (HRs) with 95% confidence intervals (CIs) of overall 5-year and 90-day mortality. Model 1 was adjusted for age, sex, year of the surgery, comorbidities, histology, pathological stage, and neoadjuvant therapy. Model 2 included also albumin level and BMI. Result: Of 1064 patients, a total of 134 patients underwent preoperative stenting and 930 did not. In both adjusted models 1 and 2, higher 5-year mortality was seen in patients with preoperative stent with HRs of 1.29 (95% CI 1.00–1.65) and 1.25 (95% CI 0.97–1.62), respectively, compared to no stenting. The adjusted HR of 90-day mortality was 2.49 (95% CI 1.27–4.87) in model 1 and 2.49 (95% CI 1.25–4.99) in model 2. When including only neoadjuvant-treated patients, those with preoperative stent had a 5-year survival of 39.2% compared to 46.4% without stent (adjusted HR 1.34, 95% CI 1.00–1.80), and a 90-day mortality rate of 8.5% and 2.5% (adjusted HR 3.99, 95% CI 1.51–10.50). Discussion: This nationwide study reports worse 5-year and 90-day outcomes in patients with preoperative esophageal stent. Since residual confounding remains possible, observed difference could be only an association rather than the cause. publishedVersion

Published
2023

31. Long-Term Survival After Transhiatal Versus Transthoracic Esophagectomy : A Population-Based Nationwide Study in Finland

Author

the FINEGO Group, Junttila, Anna, Helminen, Olli, Helmiö, Mika, Huhta, Heikki, Kallio, Raija, Koivukangas, Vesa, Kokkola, Arto, Laine, Simo, Lietzen, Elina, Meriläinen, Sanna, Pohjanen, Vesa Matti, Rantanen, Tuomo, Ristimäki, Ari, Räsänen, Jari V., Saarnio, Juha, Sihvo, Eero, Toikkanen, Vesa, Tyrväinen, Tuula, Valtola, Antti, Kauppila, Joonas H., Tampere University, TAYS Heart Centre, and Department of Gastroenterology

Subjects
3121 Internal medicine, 3126 Surgery, anesthesiology, intensive care, radiology
Abstract

Background: No population-based studies comparing long-term survival after transhiatal esophagectomy (THE) and transthoracic esophagectomy (TTE) exist. This study aimed to compare the 5-year survival of esophageal cancer patients undergoing THE or TTE in a population-based nationwide setting. Methods: This study included all curatively intended THE and TTE for esophageal cancer in Finland during 1987–2016, with follow-up evaluation until 31 December 2019. Cox proportional hazard models provided hazard ratios (HRs) with 95% confidence intervals (CIs) of 5-year and 90-day mortality. The results were adjusted for age, sex, year of operation, comorbidities, histology, neoadjuvant treatment, and pathologic stage. Results: A total of 1338 patients underwent THE (n = 323) or TTE (n = 1015). The observed 5-year survival rate was 39.3% after THE and 45.0% after TTE (p = 0.072). In adjusted model 1, THE was not associated with greater 5-year mortality (HR 0.99; 95% CI 0.82–1.20) than TTE. In adjusted model 2, including T stage instead of pathologic stage, the 5-year mortality hazard rates after THE (HR 0.87, 95% CI 0.72–1.05) and TTE were comparable. The 90-day mortality rate for THE was higher than for TTE (adjusted HR 0.72; 95% CI 0.45–1.14). In subgroup analyses, no differences between THE and TTE were observed in Siewert II gastroesophageal junction cancers, esophageal cancers, or pN0 tumors, nor in the comparison of THE and TTE with two-field lymphadenectomy. The sensitivity analysis, including patients with missing patient records, who underwent surgery during 1996–2016 mirrored the main analysis. Conclusions: This Finnish population-based nationwide study suggests no difference in 5-year or 90-day mortality after THE and TTE for esophageal cancer. publishedVersion

Published
2022

39. Antibiotics versus placebo in adults with CT-confirmed uncomplicated acute appendicitis (APPAC III): randomized double-blind superiority trial

Author

Salminen, Paulina, primary, Sippola, Suvi, additional, Haijanen, Jussi, additional, Nordström, Pia, additional, Rantanen, Tuomo, additional, Rautio, Tero, additional, Sallinen, Ville, additional, Löyttyniemi, Eliisa, additional, Hurme, Saija, additional, Tammilehto, Ville, additional, Laukkarinen, Johanna, additional, Savolainen, Heini, additional, Meriläinen, Sanna, additional, Leppäniemi, Ari, additional, and Grönroos, Juha, additional

Published
2022
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40. Preoperative hemoglobin count and prognosis of esophageal cancer, a population-based nationwide study in Finland

Author

Jokela, Ella M.K., primary, Kauppila, Joonas H., additional, Helminen, Olli, additional, Helmiö, Mika, additional, Huhta, Heikki, additional, Kallio, Raija, additional, Koivukangas, Vesa, additional, Kokkola, Arto, additional, Laine, Simo, additional, Lietzen, Elina, additional, Meriläinen, Sanna, additional, Ohtonen, Pasi, additional, Pohjanen, Vesa-Matti, additional, Rantanen, Tuomo, additional, Ristimäki, Ari, additional, Räsänen, Jari V., additional, Saarnio, Juha, additional, Sihvo, Eero, additional, Toikkanen, Vesa, additional, Tyrväinen, Tuula, additional, and Valtola, Antti, additional

Published
2022
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45. Fatal complications after an interrupted gastric bypass operation in a patient with non-alcoholic fatty liver disease and massive obesity: a case report

Author

Käkelä, Pirjo, Rantanen, Tuomo, Paajanen, Hannu, and Virtanen, Kirsi A

Subjects
comorbidity, AcademicSubjects/MED00910, liver cirrhosis, NAFLD, laparoscopy, NASH, Case Report, jscrep/010, gastric bypass
Abstract

Obesity is closely linked to non-alcoholic fatty liver disease and non-alcoholic steatohepatitis (NASH), the latter now being the most common cause of cirrhosis in Western countries. Only a few cases have been described, such as the unexpected death after interrupted obesity surgery in a patient due to inaccurate preoperative imaging assessment. We describe a 53-year-old male patient with multiple comorbidities partly related to his obesity. A laparoscopic Roux-en-Y gastric bypass (LRYGB) was attempted. During anaesthesia, the patient had a cardiac arrhythmia and a short asystole. Intra-operative findings indicated a giant spleen and, unexpectedly, a cirrhotic liver. The LRYGB operation was interrupted. After 19 months, the patient died due to his severe comorbidities. Preoperative imaging missed the diagnosis of liver cirrhosis and related NASH. Since a challenging liver failure diagnosis cannot only rely on current imaging, we suggest that a liver biopsy is performed prior to LRYGB if preoperative imaging indicates cirrhotic liver.

Published
2021

46. Extent of Lymphadenectomy and Long-term Survival in Esophageal Cancer

Author

Gottlieb-Vedi, Eivind, Kauppila, Joonas H., Mattsson, Fredrik, Hedberg, Jakob, Johansson, Jan, Edholm, David, Lagergren, Pernilla, Nilsson, Magnus, Lagergren, Jesper, Helminen, Olli, Helmiö, Mika, Huhta, Heikki, Kallio, Raija, Koivukangas, Vesa, Kokkola, Arto, Laine, Simo, Lietzen, Elina, Meriläinen, Sanna, Ohto-nen, Pasi, Pohjanen, Vesa-Matti, Rantanen, Tuomo, Ristimaki, Ari, Räsä-nen, Jari V., Saarnio, Juha, Sihvo, Eero, Toikkanen, Vesa, Tyrvainen, Tuula, and Valtola, Antti

Published
2023
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