MRI is superior to CT for staging for Rectal Cancer - Prof. Zafar Sajjad


 Proceedings of Surgical Week for Colorectal Diseases at JPMC-III

MRI is superior to CT for staging
for Rectal Cancer - Prof. Zafar Sajjad

Any treatment must be looked at in view of
the natural history of the disease - Prof. Holm

KARACHI: MRI is superior to CT for staging for rectal cancer as it gives better prediction of adequacy of CRM but Post treatment MRI is of no benefit. This was stated by Prof.Zafar Sajjad Prof. of Radiology at Aga Khan University Hospital while speaking in the Sami Ashraf Memorial session during Surgical Week for Colorectal Diseases held at JPMC on the second day of the course i.e. October 10, 2017.  Prof. Zafar Sajjad, it may be mentioned here is son of late Prof. Sami Ashraf who was on the faculty of JPMC and  to honour him the organizers have a tradition to dedicate a session in his memory where his son is the invited guest speaker.

Speaking on accuracy and clinical consequences of MRI/CT in staging and re-staging in Rectal Cancer, Prof.Zafar Sajjad said that even today majority of the colorectal cancer imaging are being done by CT but we need to find out what is the evidence of slicing with CT. He opined that this practice was not correct and it may lead to wrong surgery and doing more harm to the patient. Imaging modality used must  predicts whether surgical resection  margins will be clear around tumours and accuracy is very  high with MRI which is above 88%. MRI in imaging, Prof.Zafar Sajjad further stated was the preferred first line modality for evaluating colorectal metastases who had initial therapy.  MRI remains the first choice for planning staging and staging for new adjuvant therapy.  Talking about MR imaging protocols, he said that MRI has high field scanner, phased array body coil, high resolution T2 in three planes besides long field T1 coronel. Prof.Zafar Sajjad then shared his personal experience at AKUH and highlighted the benefits of MRI as compared to CT in locally advanced rectal cancer. MRI, he said, cannot   differentiate between T1 and T2 but is very good in T3 T4 differentiation. He then showed some post radiotherapy slides and pointed out that MRI will give better image than CT for differentiation of tumours.

During the discussion it was pointed out that before going in for major surgery, the surgeon will like to know what it is and MRI will give better image than CT, he added.

His presentation was followed by live surgery by Prof. Holm who demonstrated APR/Anterior resection. There was a question about the recurrence of fissures. GTN treated patients, it was stated have very high about 50% recurrence. If the patient can regulate their bowl habits, recurrence is less. Post GTN headache is dose dependent. During post-operative care patient should be advised not to get constipation. Responding to another question Prof. Holm said that we do not give antihistamines to these patients. Natural history of anal fissures is that they heal. Any treatment must be looked at in view of the natural history of the disease, he remarked.