Medicine

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    Characteristics and survival of advanced untreated hepatocellular carcinoma of non-viral etiology
    (Indian Society of Gastroenterology, 2024) Ekanayaka, S.P.N.; Luke, N.; Thilakarathne, S.B.; Dassanayake, A.; Gunetilleke, M.B.; Niriella, M.A.; Siriwardana, R.C.
    INTRODUCTION AND OBJECTIVES Hepatocellular carcinoma (HCC) is an aggressive tumor and presents late. The underlying etiology of HCC is changing rapidly. HCC in Sri Lanka is unique due to its predominant non-viral etiology (nvHCC) but lacks survival data.METHOD Data was collected from patients who presented with HCC from 2011 to 2018. There were 560/568 (98.6%) nvHCC. The patients who were not candidates for tumor-specific treatment (149/560 [26.7%]) were selected. Population characteristics, demographic data, tumor characteristics, survival and factors affecting survival were analyzed.RESULTS The median age was 64 years (range 30-88) and 86% (n = 129) were males. As many as 124 (83%) were cirrhotic. The overall performance score was 80%. Nearly 21/124 tumors were detected in cirrhotic screening. Tumors were single nodular in 32 (21%), up to three nodules in 28 (18%), more than three nodules in 33 (22%) and diffusely infiltrating in 56 (37%). The major venous invasions were present in 78 (52.3%). Extra-hepatic tumor spread was seen in 19 (12.7%) (lungs 13 [72.2%], bones 2 [11.1%]). The median survival of patients receiving palliative care was three months (1-43 months). Tumor size and cirrhotic status were significant predictors in univariate analysis.CONCLUSION A quarter of nvHCCs were not amenable to treatment at presentation as they had dismal survival.
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    Quality improvement in colorectal cancer care; marching towards homegrown data
    (The College of Surgeons of Sri Lanka, 2023) Chandrasinghe, C.
    No abstract available
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    Proximal and distal rectal cancers differ in curative resectability and local recurrence
    (Baishideng Publishing Group, 2011) Wijenayake, W.; Perera, M.; Balawardena, J.; Deen, R.; Wijesuriya, S.R.; Kumarage, S.K.; Deen, K.I.
    AIM: To evaluate patients with proximal rectal cancer (PRC) (> 6 cm up to 12 cm) and distal rectal cancer (DRC) (0 to 6 cm from the anal verge). METHODS: Two hundred and eighteen patients (120 male, 98 female, median age 58 years, range 19- 88 years) comprised 100 with PRC and 118 with DRC. The proportion of T1, T2 vs T3, T4 stage cancers was similar in both groups (PRC: T1+T2 = 29%; T3+T4 = 71% and DRC: T1+T2 = -31%; T3+T4 = 69%). All patients had cancer confined to the rectum - those with synchronous distant metastasis were excluded. Surgical resection was with curative intent with or without preoperative chemoradiation (c-RT). Follow-up was for a median of 35 mo (range: 12 to 126 mo). End points were: 30 d mortality, complications of operation, microscopic tumour- free margins, resection with a tumourfree circumferential margin (CRM) of 1 to 2 mm and > 2 mm, local recurrence, survival and the permanent stoma rate. RESULTS: Overall 30-d mortality was 6% (12): PRC 7 % and DRC 4%. Postoperative complications occurred in 14% with PRC compared with 21.5% with DRC, urinary retention was the complication most frequently reported (PRC 2% vs DRC 9%, P = 0.04). Twelve percent with PRC compared with 37% with DRC were subjected to preoperative c-RT (P = 0.03). A tumour-free CRM of 1 to 2 mm and > 2 mm was reported in 93% and 82% with PRC and 88% and 75% with DRC respectively (PRC vs DRC, P > 0.05). However, local recurrence was 5% for PRC vs 11% for DRC (P < 0.001). Three and five years survival was 65.6% and 60.2% for PRC vs 67% and 64.3% for DRC respectively. No patient with PRC and 23 (20%) with DRC received an abdomino-perineal resection. CONCLUSION: PRC and DRC differ in the rate of abdomino-perineal resection, post-operative urinary retention and local recurrence. Survival in both groups was similar.
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    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.
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