Browsing by Author "Siriwardana, H.D.R.C."

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Clinical predictors of poor outcomes in hepatocellular carcinoma of nonviral aetiology
(Sri Lanka Medical Association, 2017) Siriwardana, H.D.R.C.; Niriella, M.A.; Dassanayake, A.S.; de Silva, A.P.; Gunetilleke, B.; Pathmeswaran, A.; de Silva, H.J.
INTRODUCTION & OBJECTIVES: Clinical predictors for prognosis of NASH and alcohol related (non-viral) hepatocellular carcinoma (nvHCC) is poorly described. METHODS: Patients with nvHCC, from a tertiary referral hepatobiliary clinic were prospectively screened. Clinical evaluation, liver biochemistry, pre-treatment AFP (pt-AFP) and contrast enhanced CT abdomen were performed. HCC was diagnosed using American Association for the Study of Liver Disease guidelines, and TNM staged. nvHCC was diagnosed in HCC negative for HBsAg, anti-HCVantibody, autoimmune and metabolic screening. Child-Turcotte-Pugh (CTP) and Model for End-stage Liver Disease (MELD) scores were calculated. Cox regression analysis was used to identify the factors associated with mortality. RESULTS: A total of 472 patients with nvHCC [age-64 (12-88) years; males-417 (88.3%)] were screened [261 (61.1%) had diabetes; 212 (48.8%) were regular, 85 (19.6%) social, 137 (31.6%) nonconsumers of alcohol]. 358 (83.4%) had cirrhosis [Child A (58.3%), B (32.8%), C (8.9%); median CTP 6 (1-14), MELD 11 (5-40)]. 170 (42.2%) HCCs were TNM stage 3, with median diameter 6cm (0.9-26.5). 239 (71.6%) had no vascular or visceral invasion. Median pt-AFP was 26.6ng/ml (1.16-100,000) [pt-AFP>200ng/ml: n=90 (31.4%) pt-AFP>400ng/ml: n=68 (23.8%)]. Gender, alcohol use (consumer/not), diabetes (present/absent), cirrhosis (present/absent), Child-class (A or B/C), total diameter (<5cm or ≥5cm), nodularity (single/multiple), vascular invasion (present/absent), TNM stage (early/late) and pt-AFP level (<200 or ≥200ng/ml) were assessed as predictors of mortality. On bivariate analysis, Child B/C class (p<0.05), vascular invasion (p<0.001), TNM stage 3 and 4 (p<0.05) and pt- AFP≥200ng/ml (<0.05) were predictive of death. On multivariate analysis, TNM stage ¾ (p<0.05, HR=2.07 and 4.07 respectively) and pt-AFP level≥200ng/ml (p<0.05, HR=1.71) remained independently predictive of death. CONCLUSION: Among patients with nvHCC, TNM stage 3/4 and pt-AFP≥200ng/ml independently predicts death.
Factors affecting the clinical outcome of transarteriai chemo treatment for hepatocellular carcinoma in Sri Lankan patients
(Sri lanka Medical Association, 2015) Jayatunge, D.S.P.; Siriwardana, H.D.R.C.; Niriella, M.A.; Dassanayake, A.S.; Liyanage, C.A.H.; Gunetilleke, M.B.; Upasena, A.; Sirigampola, C.; de Silva, A.P.; de Silva, H.J.
INTRODUCTION AND OBJECTIVES: Transarterial-chemo-embolization (TACE) is used for palliation of unresectable hepatocellular carcinoma (HCC). We studied the tolerability of TACE in a cohort of patients with NASH and alcoholic cirrhosis related HCC. METHOD: Of 290 patients with HCC (July 2011 -December 2014), 84 underwent TACE. They were monitored for post-TACE complications: postembolization fever (PEF), nausea and vomiting (NV), abdominal pain, infection, acute hepatic decompensation (AHD) and acute kidney injury (AK1). RESULTS: 84 patients [90.5% males, 89.2% cirrhotics, 89.2% nodular HCC, median age 63(34-84) years] underwent 111 TACE sessions. All were Child class A [69.4% sessions (n=77)] or B; ascites and portal vein invasion was present in 18 (16.2%) and 15 (13.6%), respectively. 42 (38.2%) TACE procedures resulted in complications [PEF 28 (25.2 %), NV 4 (3.6%), abdominal pain 9 (8.1%), infection 7 (6.3%), AHD 13 (11.7%), AKl 3 (2.7%)]. There were no immediate post-TACE deaths. On univariate analysis elevated serum bilirubin (p=0.046) and low serum albumin (p=0.035) predicted PEF while low serum albumin (p=0.021) and low platelet counts (p=0.041) predicted AHD. In the multivariate model, factors with p<0.200 on univariate analysis and factors derived from the previous literature were considered covariates. Female gender (p=0.029, OR=1.412), ascites (p=0.030, OR = 1.212), elevated serum bilirubin (p=0.007, OR= 4.357) and large tumour size (p=O.Q36, OR=3.603) were independent risk factors for PEF. Tumour diameter >5cm (p=0.049, OR=2.410) and elevated serum bilirubin (p=0.036, OR=1.517) predicted AHD. CONCLUSION: In NASH and alcoholic cirrhosis related HCC patients pre-procedure serum bilirubin, ascites, tumour size and female gender predicted PEF post-TACE, Tumours>5cm with elevated bilirubin predicted AHD post-TACE.
Risk factors for post operative complications, prolong ICU and hospital stay in patients with colorectal surgery
(Sri lanka Medical Association, 2015) Gunetilleke, M.B.; Jayatunge, D.S.P.; Munasinghe, A.H.E.; Jayarathne, K.D.V.S.; Liyanage, C.A.H.; Siriwardana, H.D.R.C.; Kumarage, S.K.; Deen, K.I.
INTRODUCTION AND OBJECTIVES: Identifying predictors for development of post-operative complications and prolong hospital stay will improve outcome of colorectal surgery. METHOD: Colorectal surgeries from May 2012 -February 2015 at NCTH were assessed for post¬operative complications, prolong ICU and hospital stay RESULTS: Out of 101 patients [43.6 % males, median age 52, 54.3% ASA class ll/lll ] 19 patients suffered complications (11 Sepsis, 10 respiratory complications and 4 ACS). Prolong hospital in 33 and prolong ICU stay in 14 were noted. On univariate analysis higher intra-operative fluid usage (IOFU), usage of blood products (UBP), increase blood loss and reduce usage of epidurals (RUE) predicted respiratory complications. Females, higher IOFU for sepsis and higher IOFU, UBP for ACS were predictors. Higher IOFU , higher ASA class, females, longer duration of anaesthesia ( LDOA ) for prolong ICU stay and UBP , LDOA , higher IOFU for prolong hospital stay were predictors. In multivariate model a higher IOFU, RUE for cardiorespiratory complications and low albumin & haemoglobin, female gender for sepsis were independent predictors. For prolonged ICU/ hospital stay higher IOFU (> 20 ml/kg), LDOA (> 240 min), higher ASA class were independent predictors. Patient without intra-operative vasopressors had a higher IOFU and no significance in development of complications. CONCLUSION: Patients without intra-operative vasopressor had higher IOFU. IOFU >20ml/kg is a major contributor for post-operative cardio¬respiratory complications, prolong ICU and hospital stay.