Nasogastric tube after oesophagectomy and risk of anastomotic leak: a Nordic, multicentre, open-label, randomised, controlled, non-inferiority trial.

Background: Oesophagectomy, a corner stone in curative treatment of oesophageal cancer, is a complex procedure with high complication rates. Postoperative gastric tube decompression is debated and some centres are abandoning routine nasogastric (NG) tube use. We hypothesised that postoperative NG tube removal is non-inferior to five days of NG tube decompression, with regard to the risk of anastomotic leak.

Neoadjuvant Treatment and Postoperative Complications After Surgery for Esophageal Cancer: A Population-Based, Nationwide Study in Finland.

Background: The role of neoadjuvant treatment and its modalities in the risk of complications after esophagectomy in national practice is unclear. The aim of this study was to compare postoperative complications after neoadjuvant treatment (nT) and upfront surgery (US), neoadjuvant chemoradiotherapy (nCRT) and neoadjuvant chemotherapy (nCT), and to assess the effect of complications from neoadjuvant treatment in surgical risk.

Patients And Methods: All patients undergoing esophagectomy for esophageal cancer in Finland in 2005-2016 were included.

Characteristics and significance of γδ T cells in colorectal cancer.

Gamma-delta T cells are a subset of T cells that have features of both innate and adaptive immunity. Their role in cancer remains controversial, since both anti- and protumor functions have been reported. We aimed to shed light on the distinct characteristics of γδ T cells in colorectal cancer (CRC).

Integrating Tumor Intraepithelial CD8 and Stromal FOXP3 T-Cell Densities as an Enhanced Immune Prognostic Index in Colorectal Cancer.

High immune cell infiltration is generally associated with better survival in colorectal cancer (CRC). Recently, a prognostic score called CD8-FOXP3, which integrates the densities of tumor intraepithelial CD8 and intrastromal FOXP3 cells, was introduced using multiplex immunofluorescence. In this study, we developed a triple chromogenic immunohistochemistry assay to evaluate the CD8-FOXP3 score and assessed its prognostic value in comparison with the CD3-CD8 T-cell density score (based on the principles of the Immunoscore) and conventional prognostic parameters.

Comparing Gastrectomy Complications Consensus Group (GCCG) and Esophagectomy Complications Consensus Group (ECCG) Classifications in Reporting Postoperative Complications After Gastrectomy: A Population-Based Nationwide Study in Finland.

Background: Previously, no international consensus on reporting complications after gastric cancer surgery existed, making comparisons between studies difficult. In 2015 the Esophagectomy Complications Consensus Group (ECCG) published a standardized list for classification of postoperative complications after esophagectomy for esophageal cancer, which also was applied for gastric cancer. In 2019 the Gastrectomy Complications Consensus Group (GCCG) reported outcomes after gastrectomy for gastric cancer with a list of different complication types.

Surgical complications after minimally invasive oesophagectomy compared to open oesophagectomy for oesophageal cancer: A population-based, nationwide study in Finland.

Introduction: Evidence on the safety of minimally invasive oesophagectomy (MIO) compared to open oesophagectomy (OO) in nationwide practice is lacking. The aim of this study was to compare surgical complications after MIO and OO in a nationwide, population-based, unselected cohort.

Materials And Methods: Descriptive statistics were used to report complications and complication categories defined by the Oesophagectomy Complications Consensus Group, major complications, reoperations and 90-day mortality in all patients undergoing MIO and OO in Finland during 2007-2016.

Significance of mucin-suspended tumor bud-like structures in colorectal cancer.

Tumor budding (TB) is an independent predictor of adverse prognosis in colorectal cancer (CRC), defined as clusters of fewer than 5 tumor cells at the invasive margin of cancer. According to the international consensus criteria (ITBCC), TB should be evaluated from the non-mucinous regions. However, some tumors also contain tumor bud-like structures within extracellular mucin pools, and the prognostic impact of these structures remains unclear.

Multimarker Assessment of B-Cell and Plasma Cell Subsets and Their Prognostic Role in the Colorectal Cancer Microenvironment.

Purpose: Although the association between cytotoxic T lymphocytes and favorable prognosis in colorectal cancer is well established, the prognostic significance of B lymphocytes remains more ambiguous. This study aimed to assess the characteristics and significance of various B-cell and plasma cell subsets in colorectal tumors.

Experimental Design: We designed a seven-plex IHC assay, combined with machine learning-based image analysis, to identify various B-cell and plasma cell populations and applied it to study a cohort of 912 colorectal tumors.

Epidural analgesia during esophagectomy and esophageal cancer prognosis: A population-based nationwide study in Finland.

Background: The use of epidural analgesia has been proposed to improve the prognosis of esophageal cancer by attenuating the stress response and being less immunosuppressive than opioids. This study aims to evaluate the association, if any, between non-epidural pain management compared to epidural analgesia during minimally invasive or open esophagectomy and esophageal cancer prognosis.

Materials And Methods: This was a population-based nationwide retrospective cohort study in Finland, using the Finnish National Esophago-Gastric Cancer Cohort (FINEGO).

Stroma AReactive Invasion Front Areas (SARIFA), tumour immune microenvironment, and survival in colorectal cancer.

Background: SARIFA (Stroma AReactive Invasion Front Areas), defined as the direct contact between a tumour cell cluster and adipose cells at the invasion margin, has been proposed as a prognostic marker in gastrointestinal cancers. We hypothesized that SARIFA is associated with an immunosuppressive tumour microenvironment.

Methods: SARIFA status was evaluated in two large colorectal cancer cohorts (N = 1876).

Indocyanine Green Fluorescence Imaging in Prevention of Colorectal Anastomotic Leakage: A Randomized Clinical Trial.

Importance: Performing a bowel anastomosis is a critical step in colorectal resection. Assessing the risk of anastomotic leakage remains challenging, even for experienced surgeons.

Objective: To evaluate the use of indocyanine green (ICG) fluorescence imaging in assessing perfusion at the anastomotic site before and after anastomosis and determine whether it helps reduce anastomotic leakages.

Preoperative predictors of postoperative complications after gastrectomy for gastric cancer, a population-based study in Finland.

Introduction: International studies on preoperative risk factors of postoperative complications after gastrectomy for gastric cancer are few, and studies done in a population-based setting or using standardized definitions are lacking. Gastrectomy for gastric cancer is characterized by high complication rates and mortality, and identifying the risk factors for postoperative complications and mortality enables to improve the postoperative outcomes.

Materials And Methods: This nationwide population-based cohort study is based on the Finnish National Esophago-Gastric Cancer Cohort, and it included all patients undergoing gastric cancer surgery in Finland during 2005-2016 aged 18 years or older.

CDX2 and SATB2 loss are associated with myeloid cell infiltration and poor survival in colorectal cancer.

Background: Caudal-type homeobox 2 (CDX2) and special AT-rich sequence-binding protein 2 (SATB2) are transcription factors playing important roles in intestinal homeostasis and participating in the regulation of intestinal inflammation. In colorectal cancer (CRC), reduced expression levels of CDX2 and SATB2 have been associated with poor differentiation and worse survival. However, their prognostic significance still needs further clarification, and the associations between CDX2 and SATB2 and immune cell infiltration into the CRC microenvironment are largely unknown.

Incidence trends of surgical complications after oesophagectomy for oesophageal cancer: a population-based, nationwide cohort study in Finland over 30 years.

Background: Knowledge on the incidence of surgical complications after oesophagectomy for oesophageal cancer in nationwide practice is scarce. The aim of this study was to assess complication trends after oesophagectomy in a nationwide, population-based, unselected cohort.

Methods: All patients undergoing oesophagectomy for oesophageal cancer in Finland in 1987-2016 were included.

Associations of mucinous differentiation and mucin expression with immune cell infiltration and prognosis in colorectal adenocarcinoma.

Background: The production of extracellular mucus and expression of mucins are commonly aberrant in colorectal cancer, yet their roles in tumour progression remain unclear.

Methods: To investigate the potential influence of mucus on immune response and prognosis, we analysed mucinous differentiation (non-mucinous, 0%; mucinous component, 1-50%; mucinous, >50%) and its associations with immune cell densities (determined with three multiplex immunohistochemistry assays or conventional immunohistochemistry) and survival in 1049 colorectal cancer patients and a validation cohort of 771 patients. We also assessed expression patterns of transmembrane (MUC1, MUC4) and secreted (MUC2, MUC5AC and MUC6) mucins using immunohistochemistry.

Comprehensive characterization of micropapillary colorectal adenocarcinoma.

Micropapillary colorectal adenocarcinoma is a morphologic subtype of colorectal cancer (CRC) with insufficiently characterized prognostic significance and biological features. We analyzed the histopathological, immunological, and prognostic features of micropapillary adenocarcinoma in two independent CRC cohorts (N = 1,876). We found that micropapillary adenocarcinomas accounted for 4.

Establishing Criteria for Tumor Necrosis as Prognostic Indicator in Colorectal Cancer.

Tumor necrosis has been reported to represent an independent prognostic factor in colorectal cancer, but its evaluation methods have not been described in sufficient detail to introduce tumor necrosis evaluation into clinical use. To study the potential of tumor necrosis as a prognostic indicator in colorectal cancer, criteria for 3 methods for its evaluation were defined: the average percentage method (tumor necrosis percentage of the whole tumor), the hotspot method (tumor necrosis percentage in a single hotspot), and the linear method (the diameter of the single largest necrotic focus). Cox regression models were used to calculate cancer-specific mortality hazard ratios (HRs) for tumor necrosis categories in 2 colorectal cancer cohorts with more than 1800 cases.

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

Background: The purpose of this study was to examine the rates of 90-day anastomotic complications and other postoperative complications after total or partial gastrectomy with antecolic versus retrocolic reconstruction in a population-based setting.

Methods: This population-based nationwide retrospective cohort study included all patients undergoing total or partial gastrectomy for gastric adenocarcinoma in Finland in 2005-2016, with follow-up until 31 December 2019. Logistic regression provided odds ratios (ORs) with 95% confidence intervals (CIs) of 90-day mortality.

Toll-like receptors 1-9 in small bowel neuroendocrine tumors-Clinical significance and prognosis.

Toll-like receptors (TLRs) are pattern recognition receptors of the innate immunity. TLRs are known to mediate both antitumor effects and tumorigenesis. TLRs are abundant in many cancers, but their expression in small bowel neuroendocrine tumors (SB-NETs) is unknown.