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Background The lack of uniform criteria for coding of gastroenteropancreatic neuroendocrine neoplasia ( GEP-NEN) has hampered previous epidemiological studies. The epidemiology of GEP-NEN was investigated in this study using currently available criteria. Methods All patients diagnosed with GEP-NEN between January 2003 and December 2013 in a well defined Norwegian population of approximately 350 000 people were included. Age- and sex-adjusted incidence rates were calculated. The current 2010 World Health Organization criteria, European Neuroendocrine Tumour Society classification and International Union Against Cancer ( UICC) classification were used. Results A total of 204 patients (114 male, 55·9 per cent) were identified. The median age at diagnosis was 61 (range 10-94) years. The annual overall crude incidence was 5·83 per 100 000 inhabitants, with an increasing trend ( P = 0·033). The most frequent location was small intestine (60 patients, 29·4 per cent) followed by appendix (48 patients, 23·5 per cent) and pancreas (33 patients, 16·2 per cent). Grade 1 tumours were more common in gastrointestinal (100 patients, 58·5 per cent) than in pancreatic (9 patients, 27 per cent) NEN. According to the UICC classification, 77 patients (37·7 per cent) had stage I, 17 patients (8·3 per cent) stage II, 37 patients (18·1 per cent) stage III and 70 patients (34·3 per cent) had stage IV disease. No patient with stage I disease had grade 3 tumours; advanced tumour grade increased with stage. Conclusion A high crude incidence of GEP-NEN, at 5·83 per 100 000 inhabitants, was noted together with a significant increasing trend over time. [ABSTRACT FROM AUTHOR]

Esophageal perforation is associated with significant mortality, and this may markedly increase with advanced age. This multicenter study investigates this issue in patients older than 80 years. Data on 33 patients >80 years old who underwent conservative (10 patients), endoclip (one patient), stent grafting (11 patients), or surgical treatment (11 patients) for esophageal perforation were collected from nine centers. Surgical repair consisted of repair on drain in one patient, primary repair in seven patients, and esophagectomy in two patients. Among patients who underwent stent grafting, one required repeat stenting and another stent graft repositioning. One patient was converted to surgical repair after stent grafting. Thirteen patients (39.4%) died during the 30-day and/or in-hospital stay. Their mortality was significantly higher than in a series of patients <80 years old (13.0%, 21/161 patients, P = 0.001). Three patients (30.0%) died after conservative treatment, one (100%) after treatment with endoclips, five (45.5%) after stent grafting, and four (36.4%) after surgical repair ( P = 0.548). Early survival with salvaged esophagus was 42.4% (conservative treatment: 70.0% endoclips 0%, stent grafting: 54.5%, and surgical repair: 54.5%, respectively, P = 0.558). Estimated glomerular filtration rate <60 mL/minute/1.73 m2 (70.0% vs. 25.0%, P = 0.043) and sepsis (100% vs. 32.1%, P = 0.049) at presentation were associated with increased risk of early mortality in univariate analysis. Esophageal perforation in octogenarians is associated with very high early and intermediate high mortality irrespective of the treatment method used. [ABSTRACT FROM AUTHOR]

Background Perforated peptic ulcer ( PPU) is a common surgical emergency that carries high mortality and morbidity rates. Globally, one-quarter of a million people die from peptic ulcer disease each year. Strategies to improve outcomes are needed. Methods PubMed was searched for evidence related to the surgical treatment of patients with PPU. The clinical registries of trials were examined for other available or ongoing studies. Randomized clinical trials ( RCTs), systematic reviews and meta-analyses were preferred. Results Deaths from peptic ulcer disease eclipse those of several other common emergencies. The reported incidence of PPU is 3·8-14 per 100 000 and the mortality rate is 10-25 per cent. The possibility of non-operative management has been assessed in one small RCT of 83 patients, with success in 29 (73 per cent) of 40, and only in patients aged less than 70 years. Adherence to a perioperative sepsis protocol decreased mortality in a cohort study, with a relative risk ( RR) reduction of 0·63 (95 per cent confidence interval (c.i.) 0·41 to 0·97). Based on meta-analysis of three RCTs (315 patients), laparoscopic and open surgery for PPU are equivalent, but patient selection remains a challenge. Eradication of Helicobacter pylori after surgical repair of PPI reduces both the short-term ( RR 2·97, 95 per cent c.i. 1·06 to 8·29) and 1-year ( RR 1·49, 1·10 to 2·03) risk of ulcer recurrence. Conclusion Mortality and morbidity from PPU can be reduced by adherence to perioperative strategies. [ABSTRACT FROM AUTHOR]