Browsing by Author "Hewavissenthi, J."

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Neoadjuvant chemoradiation for rectal cancer achieves satisfactory tumour regression and local recurrence - result of a dedicated multi-disciplinary approach from a South Asian Centre
(BioMed Central, 2023) Deen, R.; Ediriweera, D.S.; Thillakaratne, S.; Hewavissenthi, J.; Kumarage, S.K.; Chandrasinghe, P.C.
BACKGROUND: Pre-operative long-course chemoradiotherapy (CRT) for rectal cancer has resulted in improvement in rates of restorative rectal resection and local recurrence by inducing tumour downstaging and downsizing. Total mesorectal excision (TME) is a standardised surgical technique of low anterior resection aimed at the prevention of local tumour recurrence. The purpose of this study was to evaluate tumour response following CRT in a standardised group of patients with rectal cancer. METHODS: One hundred and thirty-one patients (79 male; 52 female, median age 57; interquartile range 47-62 years) of 153 with rectal cancer who underwent pre-operative long-course CRT were treated by standardised open low anterior resection at a median of 10 weeks post-CRT. Sixteen of 131 (12%) were 70 years or older. Median follow-up at the time of analysis was 15 months (interquartile range 6-45 months). Pathology reports were analysed based on AJCC-UICC classification using the TNM system. Data recorded were overall/subgrades of tumour regression; good, moderate or poor, lymph node harvest, local recurrence, disease-free and overall survival using standard statistical methods. RESULTS: 78% showed tumour regression post-CRT; 43% displayed good tumour regression/response while 22% had poor tumour regression/response. All patients had a pre-operative T-stage of either T3 or T4. Post-operation, good responders had a median T stage of T2 vs. T3 in poor responders (P = 0.0002). Overall, the median lymph node harvest was < 12. There was no difference in the number of nodes harvested in good vs. poor responders (Good/moderate-6 nodes vs. Poor- 8; P = 0.31). Good responders tended to have a lesser number of malignant nodes vs. poor responders (P = 0.31). Overall, local recurrence was 6.8% and the anal sphincter preservation rate was 89%. Predicted 5-year disease-free and overall survival were similar between good and poor responders. CONCLUSION: Long-course CRT resulted in satisfactory tumour regression and enabled consideration for safe, sphincter-saving resection in rectal cancer. A dedicated multi-disciplinary team approach achieved a global benchmark for local recurrence in a resource-limited setting.
Trends in early onset colorectal cancer (EOCRC) in a South Asian cohort: data from a specialized tertiary care center in western Sri Lanka
(The College of Surgeons of Sri Lanka, 2022) Chandrasinghe, P.; Godahewa, S.; Mahendra, G.; Hewavissenthi, J.; Kumarage, S.
Introduction Early onset colorectal cancer [EOCRC] has significantly increased during the past decade globally. It is defined as cancers diagnosed in those aged 50 years or less. Most research on EORC are from western populations where the tumour biology and risk factors may differ from other regions. Evidence on EOCRC from the South Asian region is particularly scarce. This study presents the basic trends in presentation and overall survival [OS] pattern of EOCRC using data from a single specialized tertiary care institution over two decades. Methods A total of 723 patients treated at the University surgical unit of the North Colombo teaching hospital from 1995 to 2020 were included in the analysis. Overall survival of the EOCRC was compared with that of the older population using Kaplan- Meier survival curves. Survival patterns over two time periods [pre-2010 vs post-2010] were also compared between the two populations. The stage at presentation, family history of colorectal or related cancers, tumour site, and tumour stage were also compared. Results The proportion of EOCRC in this cohort has not shown a significant increase over the past two decades [2001-2010: 24% vs 2011-2020: 21%]. The advanced tumour stage at presentation and the presence of significant family history are also comparable. EOCRC cohort demonstrates a better OS for the entire study period [Median survival: < 50 years – not reached; >50 years – 91 months; 95%CI – 72-132; P<0.001]. However, this survival advantage is only observed during the pre-2010 period [Median survival: < 50 years – 160 months; 95%CI – 120 – not reached; >50 years – 84 months; 95%CI – 62-132; P=0.01] and becomes comparable in the 2010-2020 period [P=0.16]. OS of the EORC has not also improved over the two decades from 2001 to 2020 [P=0.51]. Conclusion There is no significant increase in the EOCRC rates in this population over time although the rate has remained high throughout. The OS of the EOCRC population is better compared to the older population. A significantly better OS is observed during the pre-2010 period in the EOCRC but is not present in the post-2010 period. Advancement in therapy may have improved the survival of the older population during the latter part but not that in the EOCRC due to its inherently aggressive nature. This paper provides preliminary data on EOCRC from Sri Lanka. The South Asian population may have a different disease pattern with younger age at onset compared to the western populations and needs to be further explored.