A Study on the accuracy and development of best practices using fluorescence for precision surgery in colorectal cancer

Background and study aims
Surgery for colon cancer is still variable because we don’t know exactly how much surrounding tissue to remove along with the main primary cancer. Recurrence risk (i.e. risk of the cancer coming back or spreading elsewhere) could be lowered if we can remove this important nearby tissue with greater precision. Although some surgeons have suggested performing a bigger operation to remove more of the surrounding tissue, a bigger operation potentially has complications and it may be unnecessary for certain patients. By using a specialised dye at the time of surgery we may be able to better define exactly how much surrounding tissue needs to be removed in each patient thus reducing that specific patient’s individual risk of recurrence. If we remove the cancer and precisely the right amount of tissue nearby that might also contain cancer cells, this could reduce the chances of spread to other sites such as the liver. If successful, this technique will allow each operation to be tailored to each patient. A patient who doesn’t need a bigger radical operation would be spared such ‘over-treatment’, Conversely, a patient who does actually need a bigger operation to minimise the chance of residual cancer cells being left behind would gain benefit from having a bigger operation upfront to avoid potential ‘under-treatment’. The aim of this study is to examine the validity of using indocyanine green (ICG) fluorsecence imagining has the ability to guide proper cancer resections (tumour removal) in colorectal cancer.
Who can participate?
Adults aged 18 and older who are scheduled to have a colorectal resection.
What does the study involve?
Participants are identified from the colorectal cancer multidisciplinary team meeting who are suitable for surgery. Their treatment plans remain the same. During the operation, participants are injects a dye next to the cancer and then use a special camera to highlight all the potential tissue nearby that might have some cancer cells within it. This allows the surgeon to remove the main primary cancer and precisely the right amount of surrounding tissue. The normal treatment for colorectal cancer is to remove the cancerous part of the bowel. In addition surrounding normal bowel is also removed. This is to ensure that the cancer is removed completely. Once the bowel has been removed for your tummy we would then take some tissue samples from the specimen that is analysed to see how well this method works at removing the cancer cells.