Browsing by Author "Atulugama, N.S."

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Effectiveness of prophylactic central compartmental neck dissection in papillary thyroid cancer
(College of Surgeons of Sri Lanka, 2015) Atulugama, N.S.; Bandaranayake, B.M.V.C.; de Silva, G.K.S.; Ariyapala, K.S.K.; Ediriweera, E.P.D.S.
INTRODUCTION: Standard treatment for Papillary thyroid cancer is Total Thyroidectomy (TT) and selective block dissection for node positive disease. Incidence of central compartmental nodal (CCN) involvement esimated to be 30-70% though preoperative staging is suboptimal due to anatomical location. Therefore, many advocate Prophylactic Central Compartmental Neck Dissection (PCCND) as a staging and therapeutic procedure, but others believe no added therapeutic value despite higher incidence of complications. MATERIAL AND METHODS: All pathological reports of patients who have undergone TT with PCCND for Papillary thyroid cancer in a single unit from 2014 January to 2015 June was collected and entered into a database. Clinical node negativity was considered when both examination and pre-op USS was negative. This is a single unit experience and our routine practice is to do PCCND in all clinically node negative disease patients. Pearson's chisquare test and Fishers exact statistical tools were used to assess predictors of CCN involvement. P < 0.05 was considered as significant. RESULTS: Total of 27 cases found and 20 (74%) cases didn't reveal a single positive node. Nineteen had unifocal disease of thryroid and only 5 (26%) had ipsilateral CCN positivity. Six patients had multifocal disease and 3 had positive CCN disease. Positive predictors of CCN: Clinical stage, Multifocal disease, Histological type, Vascular invasion and age are not significantly associated. Fourteen (52%) patients had at least 1 parathyroid gland included in the specimen. CONCLUSIONS: Nearly 3/4 of patients undergo unnecessary PCCND. Further studies are needed assess the predictors of CCN involvement.
Goitre prevalence in diabetes - results of an islandwide study
(Sri Lanka Medical Association, 2008) Fernando, R.; Hewavisenthi, J.; Atulugama, N.S.; Edirisinghe, E.M.D.A.R.; Abeysinghe, A.P.S.D.; Fernando, W.M.T.P.S.; Premathilaka, H.M.M.S.; Bandara, S.D.
Abstracts Available
Inorganic content of water and prevalence of goitre in Sri Lanka
(College of Surgeons of Sri Lanka, 2009) Fernando, R.; Pathmeswaran, A.; Atulugama, N.S.; Mubarak, M.N.A; Edirisinghe, E.M.D.A.R.; Abeysinghe, A.P.S.D.; Fernanado, W.M.T.P.S.; Premathilaka, H.M.M.S.
BACKGROUND: Total thyroidectomy is increasingly recognised as the preferred surgical option for benign diseases of the thyroid. One factor contributing towards this change in policy is reports of incidental carcinomas in the resected specimens. METHODS: This was a prospective study of patients, who underwent total thyroidectomy for benign diseases of the thyroid at the University Surgical Unit, Colombo North Teaching Hospital from January 2003 to December 2005. RESULTS: There were 68 patients (67 females) aged 28 to 67 years (mean 44.2 (SD=11.1). In 6 (8.8%) patients, histological examination of the post-operative specimen showed incidental carcinomas: 2 papillary, 2 medullary and 2 follicular carcinomas. There was no significant difference in age, clinical presentation and functional thyroid status of patients with incidental carcinomas and those with histologically confirmed benign diseases. CONCLUSIONS: Occurrence of incidental thyroid cancers was 8.8% in this series, and they were difficult to predict pre-operatively. The policy of performing total thyroidectomy for benign disease of the thyroid obviates the need for further surgery if an incidental carcinoma is found
Outcome of minimally invasive procedures for early breast cancer
(College of Surgeons of Sri Lanka, 2015) Atulugama, N.S.; Bandaranayake, B.M.V.C.; de Silva, G.K.S.; Ariyapala, K.S.K.; Ediriweera, E.P.D.S.
INTRODUCTION: Worldwide incidence of stage I breast cancer is around 41%. For primary breast lesions management trend has changed from mastectomy to breast conservation (BCS) and for axillary staging from routine nodal dissection (ALND) to Sentinel Lymph node Biopsy (SLNB) in clinically negative axillae. In many studies it has been proven that this paradigm shift has brought increase patient satisfaction with less morbidity and with same oncological outcome. MATERIAL AND METHODS: Patients with early breast cancer and clinically negative axillae were prospectively analysed in a single unit from January 2013. They were offered breast conservation or mastectomy (on patient's request) with SLNB. We used Isolated Methylene Blue technique (IMBT) for SLNB. All patients followed up for 2 years with standard surveillance protocol and data comprising of pre-op evaluation, surgical data, histological details and surveillance were recorded in a database. RESULTS: Total number of patients included were 253. BCS was offered for 157 (62.05%) patients. Ninety five (60.5%) had Primary closure, 49(31.2%) had Volume displacements and 15 (9%) had Volume replacements. Twenty eight patients needed re-surgery immediately due to inadequate margins and 14 ended up in mastectomy. Out of mastectomy patients 6 had TRAM and 4 had LD immediate reconstructions. Median age for BCS 53yrs and mastectomy 54yrs. Only 3 patients had axillary recurrences but no breast recurrences during the study period. CONCLUSIONS: BCS and SLNB with IMBT can be offered for early breast cancer patients with non-inferior oncological outcome compared to standard treatment of mastectomy and axillary clearance.
Positive predictors of sentinel Lymphnode positivity
(College of Surgeons of Sri Lanka, 2015) Atulugama, N.S.; Bandaranayake, B.M.V.C.; de Silva, G.K.S.; Ariyapala, K.S.K.; Ediriweera, E.P.D.S.
INTRODUCTION: Lymph node status is the single most important prognostic and predictive factor in breast cancer. Therefore, place of proper axillary staging is invaluable and it was routine to perform an axillary Lymph node dissection. Currently, Sentinel Lymph node Biopsy (SLNB) is an oncologically accepted technique for axillary staging in clinically negative axillae with less morbidity. Positive predictors for a histologically positive sentinel lymph node (SLN) are multifactorial. MATERIAL AND METHODS: We did a prospective analytical study since January 2013 in a single unit in patients with early breast cancer and clinically negative axillae. They were offered mastectomy or breast conservation with SLNB. We used Isolated Methylene Blue technique for SLNB. All data regarding pre-op evaluation, surgical data and histological details are recorded in a database. Pearson's chisquare test, Fishers exact test and logistic regression statistical tools were used. P < 0.05 was considered as significant. RESULTS: Total number of patients included were 253 and 48 (18.97%) had histologically Positive SLN. Median SLN harvest was 3. Predictors SLN positivity: on univariate analysis Pathological SLN size, Clinical T stage (T2 vs