Incidence, patterns of care and prognostic factors for outcome of gastroenteropancreatic neuroendocrine tumors (GEP-NETs): results from the National Cancer Registry of Spain (RGETNE).

BACKGROUND: Neuroendocrine tumors (NETs) are an unusual family of neoplasms with a wide and complex spectrum of clinical behavior. Here, we present the first report of a National Cancer Registry of gastroenteropancreatic neuroendocrine tumors from a Southern European country. PATIENTS AND METHODS: Data was provided online at www.retegep.net by participating centers and assessed for internal consistency by external independent reviewers. RESULTS: The study cohort comprised 907 tumors. The most common tumor types were carcinoids (55%), pancreatic nonfunctional tumors (20%), metastatic NETs of unknown primary (9%), insulinomas (8%) and gastrinomas (4%). Forty-four percent presented with distant disease at diagnosis, most often those from small intestine (65%), colon (48%), rectum (40%) and pancreas (38%), being most unusual in appendix primaries (1.3%). Stage at diagnosis varied significantly according to sex, localization of primary tumor, tumor type and grade. Overall 5-year survival was 75.4% (95% confidence interval 71.3% to 79.5%) and was significantly greater in women, younger patients and patients with hormonal syndrome and early stage or lower grade tumors. Prognosis also differed according to tumor type and primary tumor site. However, stage and Ki-67 index were the only independent predictors for survival. CONCLUSION: This national database reveals relevant information regarding epidemiology, current clinical practices and prognosis of NETs in Spain, providing valuable insights that may contribute to understand regional disparities in the incidence, patterns of care and survival of this heterogeneous disease across different continents and countries.

[Preoperative nutritional status in geriatric patients with digestive neoplasm]. / Estado nutricional preoperatorio en el paciente geriátrico y portador de una neoplasia digestiva.

Between October 1987 and January 1989, a prospective study was performed on the nutritional state of 100 elderly patients aged 65 and over, with digestive neoplasia. We found that 47% were suffering from malnutrition. This was associated to greater postoperative complications and mortality, and prealbumin and weight-loss percentages were the nutritional parameters most often altered, and which showed better correlations to the development of postoperative complications. Based on these two parameters, we prepared a classification system for these patients, dividing them into three surgical risks groups from the nutritional standpoint, which enabled us to select those patients who would most benefit from preoperative nutritional support, and evaluate the effectiveness of this treatment in reducing postoperative complications and mortality, by means of a corresponding prospective study.

[Angiodysplasia of the colon: a presentation of 7 cases]. / Angiodisplasias del colon: presentación de siete casos.

Angiodysplasias of the colon are small vascular lesions that probably affect 25% of the population over 50 years. As a result of selective arteriography the number of diagnoses of lower gastrointestinal hemorrhage (HDB) caused by a colonic angiodysplasia (CA) has increased considerably. Seven new cases of colonic angiodysplasia (6 cecal and 1 rectal) are presented, all diagnosed by arteriography. In 6, treatment was surgical and in one, medical. The postoperative bleeding recurrence was 33.3%.

[Spontaneous cholecystocolonic fistulas. Presentation of 5 cases]. / Fístulas colecistocólicas espontáneas. Presentación de cinco casos.

From 1979 to 1987, 5 patients with cholecystocolonic fistula were operated on in our service, which represents 25% of a total of 20 external biliodigestive fistulas complied over this period. Admission was as an emergency in 4 of the 5 patients (80%), and in one for elective programmed surgery. External biliodigestive fistula was suspected in 3 patients (60%) and biliocolonic fistula in one (20%), on observing aerobilia and leakage of contrast into the hepatic angle of the colon. On two occasions (40%) associated choledocholithiasis was detected, by means of echographic study in one case and intraoperative cholangiography in the other. Antecedents of biliary pathology were present in 3 of our 5 observations (60%), with a mean time of evolution of 12 years.