Biomedical subjects
Publications and source records attributed to W Seifart.
The simple and safe technical supply of ostomy is the patients indicator for life quality after an operation with performing colostomy. Therefore the correct choice of place, form and size is important as the guarantee of a sufficient perfusion of colostomy wall.
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The glass-rectoscope, developed by P. Dewey is a cylinder speculum with a closed end and a working window at the side. This is a cheap instrument and method for transanal approach to the lower rectum. After preparation of the patient by saline lavage the day before operation and one dose antibiotic preoperatively, the operation is performed under general or epidural anesthesia. The digital slow dilatation of the anal sphincter is followed by introduction of the instrument, of which several versions are available. After focusing the lesion in the working window, diathermy-excision of the mucosa or of the total rectal wall is performed. Bleeding is controlled by electrocoagulation or by continuous suture of the resulting defect in the rectal wall. In 34 patients treated by transanal tumour resection, there was one local infection and four postoperative haemorrhages required operative revision by resuture. The method is suitable for removing lesions of the lower rectum up to the diameter of 2 cm and for stage T1N0 malignant lesions.
103 cases have been analyzed retrospectively to define the indication for local extirpation of small and deep-seated rectum carcinomas with curative purpose. While pedunculated carcinomatous adenomas can be removed by endoscopic loop extraction, the non-sessile polypous carcinomas have to be radically extirpated by excision from intestinal wall resection is a promising procedure. Here, the transanal access by means of a funnel-shaped, lateral fenestrated glass speculum as introduced by Dewey yields better results than the rectotomia posterior.
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The decision findings for a risk-dependent therapeutic strategy in oncology needs an individual prognostic estimation of the risk of recurrence. That target event permits the simultaneous classification of the case in an determined therapeutic modality. In according to Bayes' formula it is possible to estimate the risk of recurrence using one or several factors. It requires beforehand the research of every factor for his influence on the target variable by calculation of sensitivity and specificity in a reclassification matrix of an independent test group. Several factors increase the expense of procedures in such a manner that it is only possible to realize the calculations by a discriminance analysis or a multiple correlation analysis using a comfortable computer program. However this procedure is required because the oncologic prognosis models always represent multivariate nonlinear connections.
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An analysis was made of therapeutic results obtained from 6,220 cases of primary gastric carcinoma and from 1,308 cases of radical surgery, as listed in the 1976 National Cancer Record of the GDR. Results were examined relative to the number of radical operations per annum. Involved in the above treatment of gastric carcinoma were 237 surgical wards throughout the GDR. Numbers of radical operations were between one and four per annum in 56.1 per cent of all wards (Group I), between 5 and 19 in 40.5 per cent (Group II), and 20 or more in only 3.4 per cent (Group III). Radical removability accounted for 13.2 per cent of all cases in Group I, 28.2 per cent in Group II, and 38.5 per cent in Group III. Better therapeutic results relative to the number of radical operations per annum were reflected in the following absolute five-year survival rates: 3.4 per cent in Group I, 6.8 per cent in Group II, and 10.6 per cent in Group III. These findings are likely to support the advisability of regional centralisation of treatment for stomach carcinoma.
In 1976, the National Cancer Registry of the GDR registered 488 cases with radical distal gastrectomy for carcinoma of the gastric antrum. 78.7% of them were treated with Billroth-II and 21.3% with Billroth-I. There were no striking differences regarding the postoperative lethality with 15.1% and 14.4% respectively. With 31.2% and 29.0% the 5-year survival was similar for both surgical methods, too. These results indicate the possibility of performing the Billroth-I-gastrectomy in distal gastric cancer if the principles of surgical oncology are carefully observed.
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At present international the regional cytostatic chemotherapy for hepatic metastases is used by the intraarterial way. Newest methods are the technically very pretentious intraarterial perfusion with venous hemofiltration and the chemo-embolization of the hepatic artery requiring meanwhile an adjuvant systemic chemotherapy because the chemo-embolization influences only the arterially supplied part of the metastases. By the combination of the transumbilical intraportal chemotherapy formerly developed in the Central Institute for Cancer Research Berlin-Buch with the intraarterial chemo-embolization it is possible to reduce considerably the technical expenditure and to increase the regional concentration of cytostatics simultaneous avoiding the load of the whole organism. The bases of this new method and the technical procedure are discussed.
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By long-time follow-up studies the authors maintain that the prognosis of colonic cancer is determined by distant metastases whereas the prognosis of rectal cancer after surgery for cure is essentially dependent on local recurrences. From that the consideration is derived to improve the prognosis of colonic cancer by an adjuvant chemotherapy, and of rectal cancer by increasing locoregional radicality which can only be attained by preoperative and/or postoperative irradiation. The individual risk of recurrence should be the indicator for an adjuvant therapy in addition to surgery. Some histological signs (grading of the tumour, cellular stromal reaction on the tumour site) correlate with prognosis and risk of recurrence. In this way it seems to be possible to define the high risk cases which may be improved by an adjuvant therapy.
During a period of 8 years 20 patients suffering from early rectal cancer underwent transanal local removal of the tumour. In comparison to postoperative mortality rate, survival time and quality of life (colostomy!) after abdominoperineal exstirpation of the rectum the transanal local approach yielded satisfying results. Accurate diagnosis is imperative. Besides cure the indication for this type of surgery is the most important diagnostic method to identify small rectal carcinomata.
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Treatment results are reported about 6 220 cases, registered in the National Cancer Registry of the GDR in 1976. 43.7% had only a symptomatic treatment. 56.0% were operated and only 21.0% were resected. Overall postoperative mortality was 20.6%. Out of these patients resected radically only 24.7% had a 5-year-survival. The overall 5-year-survival rate was 5.1%. Regarding site, stage and surgical methods these results are not satisfying and have to be improved. Therefore, the necessity of regional concentration of gastric cancer treatment is emphasized.
The report is based on the analysis of 380 cases. There was an absolute 5-year-survival rate of 12.6%, and a relative 5-year-survival rate of 25.3%. The dependence of late results on factors characterizing the tumorous process has been analysed and the modalities for improving the results are discussed.