Publications by authors named "J H Kauppila"

111 Publications

Extent of Lymphadenectomy and Long-Term Survival in Esophageal Cancer.

Ann Surg 2021 Jun 25. Epub 2021 Jun 25.

Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden Cancer and Translational Medicine Research Unit, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland Department of Surgical Sciences, Uppsala University Department of Surgery, Skåne University Hospital, Lund; Faculty of Medicine, Clinical Sciences, Lund University Department of Surgery, Linköping University, Linköping, Sweden Surgical Care Science, Department of Molecular medicine and Surgery, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden Department of Surgery & Cancer, Imperial College London, London, UK Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Department of Upper Abdominal Diseases, Karolinska University Hospital School of Cancer and Pharmaceutical Sciences, King's College London, and Guy's and St Thomas' NHS Foundation Trust, London, UK.

Objective: To examine the hypothesis that survival in esophageal cancer increases with more removed lymph nodes during esophagectomy up to a plateau, after which it levels out or even decreases with further lymphadenectomy.

Summary Background Data: There is uncertainty regarding the ideal extent of lymphadenectomy during esophagectomy to optimize long-term survival in esophageal cancer.

Methods: This population-based cohort study included almost every patient who underwent esophagectomy for esophageal cancer in Sweden or Finland in 2000-2016 with follow-up through 2019. Degree of lymphadenectomy, divided into deciles, was analyzed in relation to all-cause 5-year mortality. Multivariable Cox regression provided hazard ratios (HR) with 95% confidence intervals (95% CI) adjusted for all established prognostic factors.

Results: Among 2,306 patients, the 2nd (4-8 nodes), 7th (21-24 nodes) and 8th decile (25-30 nodes) of lymphadenectomy showed the lowest all-cause 5-year mortality compared to the 1st decile (HR = 0.77, 95% CI 0.61-0.97, HR = 0.76, 95% CI 0.59-0.99, and HR = 0.73, 95% CI 0.57-0.93, respectively). In stratified analyses, the survival benefit was greatest in decile 7 for patients with pathological T-stage T3/T4 (HR = 0.56, 95% CI 0.40-0.78), although it was statistically improved in all deciles except decile 10. For patients without neoadjuvant chemotherapy, survival was greatest in decile 7 (HR = 0.60, 95% CI 0.41-0.86), although survival was also statistically significantly improved in deciles 2, 6, and 8.

Conclusion: Survival in esophageal cancer was not improved by extensive lymphadenectomy, but resection of a moderate number (20-30) of nodes was prognostically beneficial for patients with advanced T-stages (T3/T4) and those not receiving neoadjuvant therapy.
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http://dx.doi.org/10.1097/SLA.0000000000005028DOI Listing
June 2021

Health-related quality of life following total minimally invasive, hybrid minimally invasive or open oesophagectomy: a population-based cohort study.

Br J Surg 2021 Jun;108(6):702-708

Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.

Background: Minimally invasive oesophagectomy has been shown to reduce the risk of pulmonary complications compared with open oesophagectomy, but the effects on health-related quality of life (HRQoL) and oesophageal cancer survivorship remain unclear. The aim of this study was to assess the longitudinal effects of minimally invasive compared with open oesophagectomy for cancer on HRQoL.

Methods: All patients who had surgery for oesophageal cancer in Sweden from January 2013 to April 2018 were identified. The exposure was total or hybrid minimally invasive oesophagectomy, compared with open surgery. The study outcome was HRQoL, evaluated by means of the European Organisation for Research and Treatment of Cancer questionnaires QLQ-C30 and QLQ-OG25 at 1 and 2 years after surgery. Mean differences and 95 per cent confidence intervals were adjusted for confounders.

Results: Of the 246 patients recruited, 153 underwent minimally invasive oesophagectomy, of which 75 were hybrid minimally invasive and 78 were total minimally invasive procedures. After adjustment for age, sex, Charlson Co-morbidity Index score, pathological tumour stage and neoadjuvant therapy, there were no clinically and statistically significant differences in overall or disease-specific HRQoL after oesophagectomy between hybrid minimally invasive and total minimally invasive surgical technique versus open surgery.

Conclusion: In this population-based nationwide Swedish study, longitudinal HRQoL after minimally invasive oesophagectomy was similar to that of the open surgical approach.
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http://dx.doi.org/10.1002/bjs.11998DOI Listing
June 2021

Monocarboxylate Transporters 1 and 4 and MTCO1 in Gastric Cancer.

Cancers (Basel) 2021 Apr 29;13(9). Epub 2021 Apr 29.

Surgery Research Unit, Medical Research Center, University of Oulu and Oulu University Hospital, 90014 Oulu, Finland.

Monocarboxylate transporters (MCTs) appear to play an important role in tumor development and aggressiveness. The present study aimed to evaluate associations between cytoplasmic MCT1, MCT4, and mitochondrial cytochrome c oxidase (MTCO1) expression and clinicopathological variables or survival in gastric cancer. : A total of 568 gastric adenocarcinoma patients were included in this retrospective cohort study. Protein expressions were detected by immunohistochemical staining. The patients were divided into low expression and high expression groups by median value. The Chi-squared test was used to compare categorical variables. The T-test was used to compare continuous variables. Expressions were analyzed in relation to 5-year survival and overall survival. Cox regression provided HRs and 95% CIs, adjusted for confounders. High cytoplasmic MCT1 expression was associated statistically significantly with higher T-class ( = 0.020). High cytoplasmic MCT4 expression was associated statistically significantly with positive lymph node status ( = 0.005) and was more common in Lauren's intestinal type ( < 0.001). Low cytoplasmic MTCO1 expression was associated statistically significantly with positive distant metastases ( = 0.030), and high cytoplasmic MTCO1 expression was associated more often with intestinal type ( = 0.044). However, MCT1, MCT4, and MTCO1 were not associated with survival. Monocarboxylate receptors seem to be associated with gastric cancer progression but have no independent prognostic relevance.
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http://dx.doi.org/10.3390/cancers13092142DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8124264PMC
April 2021

Blood alcohol levels in Finnish victims of non-ischaemic sudden cardiac death.

Ann Med 2021 12;53(1):413-419

Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.

Introduction: Non-ischaemic heart disease (NIHD) is the underlying pathology in∼20% of all sudden cardiac deaths (SCDs). Heavy drinking is known to be associated with SCD due to ischaemic heart disease, but studies on association of recent alcohol consumption and SCD in patients with NIHD are scarce. We evaluated the blood alcohol levels of autopsy verified non-ischaemic SCD victims.

Methods: Study population was derived from the Finnish Genetic Study of Arrhythmic Events (Fingesture) ( = 5869, mean age 65 ± 12, 79% males). All deaths occurred in Northern Finland during 1998-2017. All victims underwent a medico-legal autopsy. Subjects of SCD due to ischaemic heart disease were excluded.

Results: A total of 1301 (mean age 57 ± 12, 78% males) victims of SCD due to NIHD were included in the study. The blood ethanol level was elevated in 543 (42%) subjects, out of which the blood alcohol level was ≥0.10%in 339 (62%) subjects and ≥0.15%in 252 (46%) subjects. Male SCD victims had alcohol in blood more frequently compared to females (45% versus 31%,  < .001).

Conclusion: Elevated blood alcohol level is common in SCD victims due to NIHD, especially in males. Recent alcohol consumption might contribute to the subsequent SCD in many non-ischaemic SCD victims.KEY MESSAGESElevated blood alcohol level is common in victims of sudden cardiac death due to non-ischaemic heart disease, especially in males.Recent alcohol consumption may contribute to the subsequent death in many nonischemic sudden cardiac death victims.
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http://dx.doi.org/10.1080/07853890.2021.1890204DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7928009PMC
December 2021

Mortality, Reoperation, and Hospital Stay Within 90 Days of Primary and Secondary Antireflux Surgery in a Population-Based Multinational Study.

Gastroenterology 2021 Jun 13;160(7):2283-2290. Epub 2021 Feb 13.

Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom. Electronic address:

Background & Aims: Absolute rates and risk factors of short-term outcomes after antireflux surgery remain largely unknown. We aimed to clarify absolute risks and risk factors for poor 90-day outcomes of primary laparoscopic and secondary antireflux surgery.

Methods: This population-based cohort study included patients who had primary laparoscopic or secondary antireflux surgery in the 5 Nordic countries in 2000-2018. In addition to absolute rates, we analyzed age, sex, comorbidity, hospital volume, and calendar period in relation to all-cause 90-day mortality (main outcome), 90-day reoperation, and prolonged hospital stay (≥2 days over median stay). Multivariable logistic regression provided odds ratios (ORs) with 95% confidence intervals (95% CI), adjusted for confounders.

Results: Among 26,193 patients who underwent primary laparoscopic antireflux surgery, postoperative 90-day mortality and 90-day reoperation rates were 0.13% (n = 35) and 3.0% (n = 750), respectively. The corresponding rates after secondary antireflux surgery (n = 1 618) were 0.19% (n = 3) and 6.2% (n = 94). Higher age (56-80 years vs 18-42 years: OR, 2.66; 95% CI 1.03-6.85) and comorbidity (Charlson Comorbidity Index ≥2 vs 0: OR, 6.25; 95% CI 2.42-16.14) increased risk of 90-day mortality after primary surgery, and higher hospital volume suggested a decreased risk (highest vs lowest tertile: OR, 0.58; 95% CI, 0.22-1.57). Comorbidity increased the risk of 90-day reoperation. Higher age and comorbidity increased risk of prolonged hospital stay after both primary and secondary surgery. Higher annual hospital volume decreased the risk of prolonged hospital stay after primary surgery (highest vs lowest tertile: OR, 0.74; 95% CI, 0.67-0.80).

Conclusion: These findings suggest that laparoscopic antireflux surgery has an overall favorable safety profile in the treatment of gastroesophageal reflux disease, particularly in younger patients without severe comorbidity who undergo surgery at high-volume centers.
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http://dx.doi.org/10.1053/j.gastro.2021.02.022DOI Listing
June 2021