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Dive into the research topics where Ralf Steinert is active.

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Featured researches published by Ralf Steinert.


British Journal of Surgery | 2005

Protective defunctioning stoma in low anterior resection for rectal carcinoma

I. Gastinger; F. Marusch; Ralf Steinert; Stefanie Wolff; F. Koeckerling; H. Lippert

Anastomotic leak is a serious complication of resection for low rectal carcinoma.


World Journal of Surgery | 2005

The Impact of the Risk Factor “Age” on the Early Postoperative Results of Surgery for Colorectal Carcinoma and Its Significance for Perioperative Management

F. Marusch; A. Koch; Uwe Schmidt; Ralf Steinert; Torsten Ueberrueck; Reinhard Bittner; Eugen Berg; Rainer Engemann; Klaus Gellert; Rainer Arbogast; Thomas Körner; F. Köckerling; I. Gastinger; H. Lippert

The risks and benefits of surgery for colorectal cancer in old patients have not been unequivocally defined. The present investigation was carried out in 309 hospitals as a prospective multicenter study. In the period between 1 January 2000 and 31 December 2001, a total of 19,080 patients were recruited for the study; 16,142 (84.6%) patients were younger than 80 years (<80) and 2932 (15.4%) were 80 years and older (≥ 80). Significant differences between the age groups were observed for general postoperative complications (22.3% for <80 years; 33.9% for ≥ 80). Specific postoperative complications were identical in both groups. Overall, significantly elevated morbidity and mortality rates were found with increasing age (morbidity: 33.9% vs. 43.5%; mortality: 2.6% vs. 8.0%). The distribution of tumor stages revealed a significantly higher percentage of locally advanced tumors in the older age group (stage II: 28.0% vs. 34.4%). In contrast, no increase in metastasizing tumors was found in the older age group (stage IV: 17.4% vs. 14.1%). Logistic regression showed that, in concert with a number of other parameters, age is a significant influencing factor on postoperative morbidity and mortality. The increase in postoperative morbidity and mortality rates associated with aging is a result of the increase in general postoperative complications, in particular, pneumonia and cardiovascular complications. Age as such does not represent a contraindication for surgical treatment. The short-term outcome and quality of life are of overriding importance for the geriatric patient.


Surgical Endoscopy and Other Interventional Techniques | 2006

Palliative stent implantation in the treatment of malignant colorectal obstruction

H. Ptok; Frank Meyer; F. Marusch; Ralf Steinert; I. Gastinger; H. Lippert; L. Meyer

BackgroundPalliative surgical interventions for the management of colonic obstruction in cases of metastasized or locally irresectable colorectal carcinoma show remarkable morbidity and mortality rates for mostly older and multimorbid patients. For manifest obstruction, placement of a self-expanding metal stent (SEMS) is considered to be a suitable minimally invasive therapeutic option. This study aimed to investigate the efficacy of stent-based treatment for malignant large bowel obstruction.MethodsFrom January 1999 to June 2005, consecutive patients who had undergone placement of a SEMS for malignant colorectal obstruction were enrolled and monitored. Manifest incontinence and rectum carcinoma within 5 cm above the anocutaneous line were contraindications for SEMS implantation. For all further locations of tumor-induced stenosis, a stent was implanted using endoscopy and fluoroscopy. This case series was characterized in terms of age, carcinoma localization, complications, morbidity and mortality, and the necessity for further interventions.ResultsFor 44 of 48 patients (92%), stents were placed successfully and obstruction was abolished. The four remaining patients experienced stent dislocation. The median of age of the patients was 77.7 years (range, 47–96 years). The distribution of malignant stenoses was as follows: rectum (n = 16, 33.3%), sigmoideal colon (n = 21, 43.8%), descending colon (n = 4, 8.3%), splenic flexure (n = 2, 4.2%), transversal colon (n = 3, 6.2%), hepatic flexure (n = 1, 2.1%), and ascending colon (n = 1, 2.1%). There was no peri-interventional morbidity or mortality. The median in situ time for the stents was 251 days (mean, 422 days), with 13 of 44 patients treated with palliative therapy showing complications (29.5%). Six patients were treated endoscopically, and three individuals underwent surgical intervention. For four patients, no further intervention was required. Overall, there was no treatment-related mortality.ConclusionsFor palliative treatment of malignancy-induced colorectal obstruction, SEMS is an efficient tool associated with low morbidity and minimal mortality. From a technical point of view, all tumor locations are accessible.


Journal of Clinical Oncology | 2001

Discordance Between K-ras Mutations in Bone Marrow Micrometastases and the Primary Tumor in Colorectal Cancer

Silvia Tortola; Ralf Steinert; Marco Hantschick; Miguel A. Peinado; I. Gastinger; Peter Stosiek; H. Lippert; Werner Schlegel; Marc A. Reymond

PURPOSE To study bone marrow micrometastases from colorectal cancer patients for the presence of K-ras mutations and to compare their genotype with that of the corresponding primary tumor. PATIENTS AND METHODS Bilateral iliac crest aspiration was performed in 51 patients undergoing surgery for colorectal cancer, and bone marrow micrometastases were detected by immunohistochemistry. The presence of K-ras mutations was determined by single-strand conformation polymorphism analysis on both primary tumors and paired bone marrow samples and was confirmed by sequencing. RESULTS In six patients with primary tumor mutations, it was possible to amplify a mutated K-ras gene also from the bone marrow sample. In three of those patients the pattern of K-ras mutations differed between both samples, in two patients the mutation was identical between the bone marrow and its primary tumor, and in one patient the same mutation plus a different one were found. Fifteen of 17 K-ras mutations found in primary tumors were located in codon 12, whereas in bone marrow, five of seven mutations were found in codon 13 (P =.003). CONCLUSION Our results demonstrate that, at least for K-ras mutations, disseminated epithelial cells are not always clonal with the primary tumor and they question the malignant genotype of bone marrow micrometastases. They also indicate that different tumoral clones may be circulating simultaneously or sequentially in the same patient. Analysis of the type of mutations suggests that cell dissemination might be an early event in colorectal carcinogenesis.


Chirurg | 2006

[Long-term oncological results after laparoscopic, converted and primary open procedures for rectal carcinoma. Results of a multicenter observational study].

H. Ptok; Ralf Steinert; Frank Meyer; Kröll Kp; Scheele C; F. Köckerling; I. Gastinger; H. Lippert

ZusammenfassungHintergrundDie laparoskopische Rektumkarzinomresektionen hat eine den offenen Verfahren vergleichbare Morbidität und onkologische Sicherheit bei jedoch deutlich höherer Morbidität nach Konversion. Zu den onkologischen Langzeitergebnisse nach Konversion liegen keine Daten vor.MethodeVom 01.01.2000–31.12.2002 in einer Beobachtungsstudie erfasste Patienten mit kurativ reseziertem Rektumkarzinom wurden hinsichtlich der postoperativen Morbidität, Letalität, des tumor- und lokalrezidivfreien Überlebens nach laparoskopischer vs. konvertierter vs. offener Resektion verglichen.ErgebnisseVon 7189 Patienten wurden 237 (3,3%) laparoskopisch (ITT) reseziert. Diese Patienten hatten signifikant häufiger T1/2-Tumore (p<0,001) in früheren UICC-Stadien (p<0,001) als die offen resezierten. Die Konversionsrate betrug 14,8% (n=35). Die Konversionsgruppe hatte signifikant mehr intraoperative (p<0,001) und allgemeine postoperative Komplikationen (p=0,003) sowie die höchste Gesamtmorbidität (p=0,031) im Vergleich zur laparoskopischen und offenen Resektion. Nach einem medianen Follow-up von 30.1 Monaten zeigten die konvertierten Patienten die höchste 5-J-Lokalrezidivrate (16.0%). Nach laparoskopischer sowie offener Resektion betrug diese 3.3% resp. 12.4% (p=0.082). Die tumorfreie 5-J-Üerlebensrate war vergleichbar (p=0.585).Schlussfolgerungen Die laparoskopische Rektumkarzinomresektion bietet gegenüber der offenen Resektion vergleichbare onkologische Ergebnisse, jedoch ist nach Konversion das frühpostoperative und das onkologische Langzeit-Outcome schlechter. Bei Konversionsraten um 15% ist eine strenge Patientenselektion und Durchführung der laparoskopischen Resektion an Zentren zu fordern.AbstractBackgroundThe laparoscopic resection of rectal cancer shows morbidity and oncological safety comparable to the open approach, but morbidity increases after conversion to open resection. No oncological long-term results are available for the latter patients.MethodsFrom 01/01/2000–31/12/2002, patients with curatively resected rectal cancer enrolled in a observational study were evaluated for morbidity, mortality, tumor- and local recurrence rate, paying attention to patients with conversion from laparoscopic to open resection.Results237 (3.3%) of 7,189 patients underwent laparoscopic resection (ITT). These patients showed significantly more T1/2 tumors (P<0.001) in earlier UICC stages (P<0.001) than open resected patients. 35 (14.8%) of 237 laparoscopic procedures were converted. Compared with patients receiving complete laparoscopic or open resection, these patients showed significantly higher frequencies of intraoperative (P<0.001) and general postoperative complications (P=0.003) as well as the highest overall morbidity (P=0.031). After a median follow-up of 30.1 months, the highest 5-year local recurrence rate was found in the converted group (16.0%). The laparoscopically resected patients showed a local recurrence rate of 3.3%, patients with open resection of 12.4% (P=0.082). The disease-free survival rate did not differ between the groups (P=0.585).ConclusionLaparoscopic resection of rectal cancer provides oncological results similar to open resection. After conversion, the short and oncological long-term outcomes were worse. Considering a conversion rate of 15%, only a strict indication for the laparoscopic approach can be allowed, and laparoscopic resection should be performed at centers.


Digestive Diseases | 2002

Ethical, Legal and Economic Issues Raised by the Use of Human Tissue in Postgenomic Research

Marc A. Reymond; Ralf Steinert; J. Escourrou; G. Fourtanier

Ethical, legal and economic framework issues concerning human samples, genetic data and bioresources are rapidly evolving. In most cases, international standards have not been defined. National legislations on the use and exploitation of human sample collections differ widely. Legislations relating to intellectual property rights, access to database information for public or private bodies, of national or foreign origin, are similarly diverse. Importation and exportation rules, concerning in particular data protection, biosafety and protection of individual rights, have not always been defined. This article makes a short assessment of the legal, ethical and economic framework in selected EC countries (Germany, France and UK), and compares them with the conditions in the USA. On the basis of the information collected, it is obvious that the use of human cells, tissues and organs in medical research has to be considered as a global, worldwide question. Such use has profound ethical, cultural and economic consequences not only in the country of origin, but also globally. Biotechnology and pharmaceutical companies conducting research with human samples are facing different framework conditions in the area of data protection, policy measures, economic support, exportation, etc., that already influence trade activities and investments of such firms at the international level. Over the 3 last years, a trend towards harmonization can be recognized: the World Health Organization has recognized the problems of postgenomic medical research as a priority. The OECD has created a taskforce on centers for biological resources. Biobanks are a common theme of the French and the German National Ethic Councils. A lack of international harmonization and consistency might not only present a challenge to biotechnology and pharmaceutical companies, but can also endanger the goals the laws and regulations seek to achieve.


Archives of Surgery | 2008

Influence of Subclinical Tumor Spreading on Survival After Curative Surgery for Colorectal Cancer

Ralf Steinert; Marco Hantschick; Michael Vieth; I. Gastinger; Frank Kühnel; H. Lippert; Marc A. Reymond

OBJECTIVE To determine epithelial cell dissemination in patients with localized colorectal cancer. DESIGN Prospective observational study. SETTING Academic hospital. PARTICIPANTS Two hundred twenty-two patients operated on for colorectal cancer. MAIN OUTCOME MEASURES Epithelial cell dissemination was determined using immunohistochemistry or cytology in histologically negative lymph nodes, the peritoneal cavity, and bone marrow. Prognostic significance was determined in relation to 140 clinicopathological variables. Median follow-up was 61 months. RESULTS Of 140 patients who underwent curative surgery; 25 (17.9%) died of cancer-related causes; 10 (7.1%), of other causes; and 11 (7.8%) developed local recurrence. Tumor cells were present in the peritoneal cavity of 22% of patients, but this finding had only borderline influence on disease-free survival (P = .07). Lymph node micrometastases correlated with T category but not with survival. The presence of epithelial cells in the bone marrow was detected in 64% of patients but was not associated with tumor stage or survival. Multivariate analysis failed to identify occult tumor cell dissemination into any body compartment as an independent prognostic factor of disease-free survival. CONCLUSIONS Tumor cells disseminate into various body compartments in early stages of disease. In about two-thirds of patients, tumor cells are left in the body after so-called curative surgery. However, the presence of minimal residual disease has no independent prognostic significance in relation to established risk factors for tumor progression. Thus, other factors, such as the presence of a cellular metastatic phenotype and/or ineffective immunological response, must play an important role.


Chirurg | 2006

Operative Behandlung von Rektumkarzinomen im Vergleich

H. Ptok; Ralf Steinert; Frank Meyer; Kröll Kp; Scheele C; F. Köckerling; I. Gastinger; H. Lippert

ZusammenfassungHintergrundDie laparoskopische Rektumkarzinomresektionen hat eine den offenen Verfahren vergleichbare Morbidität und onkologische Sicherheit bei jedoch deutlich höherer Morbidität nach Konversion. Zu den onkologischen Langzeitergebnisse nach Konversion liegen keine Daten vor.MethodeVom 01.01.2000–31.12.2002 in einer Beobachtungsstudie erfasste Patienten mit kurativ reseziertem Rektumkarzinom wurden hinsichtlich der postoperativen Morbidität, Letalität, des tumor- und lokalrezidivfreien Überlebens nach laparoskopischer vs. konvertierter vs. offener Resektion verglichen.ErgebnisseVon 7189 Patienten wurden 237 (3,3%) laparoskopisch (ITT) reseziert. Diese Patienten hatten signifikant häufiger T1/2-Tumore (p<0,001) in früheren UICC-Stadien (p<0,001) als die offen resezierten. Die Konversionsrate betrug 14,8% (n=35). Die Konversionsgruppe hatte signifikant mehr intraoperative (p<0,001) und allgemeine postoperative Komplikationen (p=0,003) sowie die höchste Gesamtmorbidität (p=0,031) im Vergleich zur laparoskopischen und offenen Resektion. Nach einem medianen Follow-up von 30.1 Monaten zeigten die konvertierten Patienten die höchste 5-J-Lokalrezidivrate (16.0%). Nach laparoskopischer sowie offener Resektion betrug diese 3.3% resp. 12.4% (p=0.082). Die tumorfreie 5-J-Üerlebensrate war vergleichbar (p=0.585).Schlussfolgerungen Die laparoskopische Rektumkarzinomresektion bietet gegenüber der offenen Resektion vergleichbare onkologische Ergebnisse, jedoch ist nach Konversion das frühpostoperative und das onkologische Langzeit-Outcome schlechter. Bei Konversionsraten um 15% ist eine strenge Patientenselektion und Durchführung der laparoskopischen Resektion an Zentren zu fordern.AbstractBackgroundThe laparoscopic resection of rectal cancer shows morbidity and oncological safety comparable to the open approach, but morbidity increases after conversion to open resection. No oncological long-term results are available for the latter patients.MethodsFrom 01/01/2000–31/12/2002, patients with curatively resected rectal cancer enrolled in a observational study were evaluated for morbidity, mortality, tumor- and local recurrence rate, paying attention to patients with conversion from laparoscopic to open resection.Results237 (3.3%) of 7,189 patients underwent laparoscopic resection (ITT). These patients showed significantly more T1/2 tumors (P<0.001) in earlier UICC stages (P<0.001) than open resected patients. 35 (14.8%) of 237 laparoscopic procedures were converted. Compared with patients receiving complete laparoscopic or open resection, these patients showed significantly higher frequencies of intraoperative (P<0.001) and general postoperative complications (P=0.003) as well as the highest overall morbidity (P=0.031). After a median follow-up of 30.1 months, the highest 5-year local recurrence rate was found in the converted group (16.0%). The laparoscopically resected patients showed a local recurrence rate of 3.3%, patients with open resection of 12.4% (P=0.082). The disease-free survival rate did not differ between the groups (P=0.585).ConclusionLaparoscopic resection of rectal cancer provides oncological results similar to open resection. After conversion, the short and oncological long-term outcomes were worse. Considering a conversion rate of 15%, only a strict indication for the laparoscopic approach can be allowed, and laparoscopic resection should be performed at centers.


Digestive Surgery | 2002

Tumor Cell Dissemination during Laparoscopy: Prevention and Therapeutic Opportunities

Ralf Steinert; H. Lippert; Marc A. Reymond

Port-site recurrences (PSRs) are abdominal wall recurrences that occur in the subcutaneous tissue within a trocar site after cancer laparoscopy and are not associated with peritoneal carcinomatosis. In order to develop PSRs, viable tumor cells must be liberated from the primary tumor, be transported to a wound, and find there a favorable environment for growth. The short clinical delay in the occurrence of PSRs and their size suggest massive cell seeding into the abdominal wall. Traumatic handling of the tumor, slipping of trocars, liquid projection, as well as poor extraction techniques can all cause implantation of malignant cells into the subcutaneous tissue. Such contact can also occur postoperatively if the trocar channels remain open. Some histologies (e.g. gallbladder adenocarcinoma), the presence of ascites and advanced tumor stage are risk factors for PSRs. Further conditions – including the use of gas – might also play a limited role. The first preventive measure is the correct indication for a laparoscopic approach. Several techniques have been demonstrated to prevent PSRs in the animal model: (a) fixation of trocars to the abdominal wall; (b) prevention of leakage; (c) careful specimen handling; (d) reducing trauma to the abdominal wall; (e) specimen isolation before extraction from the abdominal cavity; (f) trocar-site irrigation with a cytotoxic solution, and (g) closure of peritoneum. Further innovative therapies are currently under investigation. In the clinical setting, correct indication, surgical expertise and application of prophylactic measures seem to be the best way to prevent the occurrence of PSRs.


Pathobiology | 2008

Lost in Translation? A Systematic Database of Gene Expression in Breast Cancer

Nasser Srour; Marc A. Reymond; Ralf Steinert

Ten years of translational research in breast cancer (BC) using high-throughput technologies such as cDNA arrays have produced an impressive amount of results. However, it is difficult for a single researcher to overview these results, since no critical synthesis is provided in the literature. This is a meta-analysis of gene expression in BC. Thirteen translational studies fulfilled the inclusion criteria, involving 553 BC patients and 79 controls. Large cohorts of patients and well-defined samples were rare. A total of 1,350 genes were reported at least once to be deregulated in BC. Out of these findings, 1,212 (90%) were not confirmed by other authors. A cohort of 138 genes of particular interest remained for further analysis. Of these, 79 were consistently reported to be overexpressed in BC, 41 to be underexpressed and in 18 cases results were contradictory. The most frequently reported deregulated genes in BC include: GATA binding protein 3, arylamine N-acetyltransferase, Myb-related protein B and zinc transporter SLC39A6 precursor (overexpressed); cadherin-3 precursor, keratin type I cytoskeletal 17 and type II cytoskeletal 5 (underexpressed). These genes obviously correlate with the presence and/or development of BC. More efforts should be devoted to the establishment of common standards in translational BC research.

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Dive into the Ralf Steinert's collaboration.

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H. Lippert

Otto-von-Guericke University Magdeburg

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I. Gastinger

Otto-von-Guericke University Magdeburg

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H. Ptok

Otto-von-Guericke University Magdeburg

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Frank Meyer

Otto-von-Guericke University Magdeburg

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Ronny Otto

Otto-von-Guericke University Magdeburg

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Marc A. Reymond

Otto-von-Guericke University Magdeburg

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R. Kube

Otto-von-Guericke University Magdeburg

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U. Schmidt

Otto-von-Guericke University Magdeburg

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F. Marusch

Otto-von-Guericke University Magdeburg

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Karsten Ridwelski

Otto-von-Guericke University Magdeburg

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