ABSTRACT
The National registry of patients with neuroendocrine tumors (NET) in Bulgaria was established in 2013 as a joint initiative of the Bulgarian Surgical Society and the Institute for Rare Diseases. The register aims to explore the epidemiology of NET in Bulgaria, as well as the different diagnostic and treatment approaches for the disease throughout the country. This the first of its kind retrospective study of NET in the country is covering the period January 2012 - January 2013. A total of 127 patients with NET were identified. At the time of the survey the average age of patients with NET was 58.61 ± 15.59 years. The data show almost equal distribution between the genders with a slight predominance of women. The largest relative part of NET is those of NET located in the gastrointestinal tract (54.10 ± 4.51%), followed by those located in the pancreas (12.30 ± 2.97%) and in the lungs (10.66 ± 2.79%). In 72.44 ± 3.96% of the patients a immunohistochemical diagnosis was performed. The study confirmed the leading role of the surgery method of the NET management. In 65.83 ± 4.33% of the patients a radical removal of the tumor was conducted, while the relative part of the undertaken partial resection was 7.50 ± 2.40%. A statistically significant association between the type of surgical treatment and during the follow-up of patients was found. An update of the information in the register will allow a more precise determining of the distribution and management of NET in Bulgaria.
Subject(s)
Gastrointestinal Neoplasms/epidemiology , Lung Neoplasms/epidemiology , Neuroendocrine Tumors/epidemiology , Pancreatic Neoplasms/epidemiology , Adult , Aged , Bulgaria/epidemiology , Female , Gastrointestinal Neoplasms/diagnosis , Gastrointestinal Neoplasms/therapy , Gastrointestinal Tract/pathology , Humans , Lung/pathology , Lung Neoplasms/diagnosis , Lung Neoplasms/therapy , Male , Middle Aged , Neuroendocrine Tumors/diagnosis , Neuroendocrine Tumors/therapy , Pancreas/pathology , Pancreatic Neoplasms/diagnosis , Pancreatic Neoplasms/therapy , Pilot Projects , Registries , Retrospective StudiesSubject(s)
Melanoma/complications , Stomach Neoplasms/secondary , Adult , Fatal Outcome , Female , Gastrointestinal Hemorrhage/complications , Gastrointestinal Hemorrhage/pathology , Humans , Melanoma/pathology , Melanoma/surgery , Stomach Neoplasms/complications , Stomach Neoplasms/diagnosis , Stomach Neoplasms/pathologySubject(s)
Intestinal Perforation/complications , Melanoma/complications , Peritonitis/etiology , Skin Neoplasms/complications , Adult , Humans , Intestinal Perforation/surgery , Male , Melanoma/pathology , Melanoma/secondary , Melanoma/surgery , Peritonitis/surgery , Skin Neoplasms/pathology , Skin Neoplasms/surgeryABSTRACT
Treatment of necrotic pancreatitis patients is still disputable, posing serious problems and a real challenge to surgeons. The surgeon's approach to the problem ranges from strictly conservative to extremely aggressive. In this paper are discussed the indications, timing and operative technique used in the treatment of necrotic pancreatitis (NP), with special attention focused on the method suggested by the authors--necrotomy and closed continuous lavage of the retroperitoneum. An algorithm of the therapeutic approach to patients presenting acute pancreatitis is likewise presented. All patients with necrotic pancreatitis are routinely referred for treatment in the intensive care unit (ICU), and mandatorily subjected to antibiotherapy. Only one-third of the cases developing infected pancreatic necrosis (IPN) within 3 weeks of admission undergo operation. Lethality among those operated on is reduced to 13 per cent, and among NP patients--4 per cent. The new concept for therapeutic approach to necrotic pancreatitis patients according to which only cases presenting evidence of infected pancreatic necrosis are liable to surgery, whereas those with SPN should be treated conservatively, is strongly supported.
