Cancer surgery at systems medicine level: simultaneous molecular mapping and resecting of solid tumours using spectroscopically guided semi-autonomous surgical robots- SU2C

In spite of the tremendous progress in cancer biology and the development of targeted drug therapies still >80% of curative interventions are surgical in case of solid tumors.

While both chemo and radiotherapy underwent significant development in the course of the last 50-years, cancer surgery still follows the original principles laid down in the late 19th century.

The current proposal is aimed at closing this gap by providing cancer surgeons with real-time cancer biology information available in-situ to augment surgical decision making and achieve higher precision in a shorter timeframe.

The primary aim of the current proposal is to develop a semi-autonomous surgical device working with cellular precision in a navigated environment.

The navigation model is created by minimally invasive medical imaging and being continuously modified based on intrasurgical optical information.

The device is envisioned to perform resection/ablation of tumours while continuously collecting metabolomics and lipidomics information, drawing a cellular resolution 3D phenotypic map of the disease by the end of the intervention.

We are planning to use laser-assisted rapid evaporative ionisation mass spectrometry (LA-REIMS), developed by the lead applicant, as core technology platform.

The LA-REIMS technology combines precise laser ablation with real-time metabolic/lipidomic profiling of the ablated tissues.

The laser will be delivered using laser fibre robot technology developed at Imperial and will be navigated by using the combination of pre-operative imaging and intraoperative optical information, the latter delivered by high-resolution cameras and probe-based confocal laser endomicroscopy (pCLE).

In order to establish a direct link between in-vivo metabolic profiling and cancer biology, a multimodal multiscale imaging dataset will be created using the Rosetta pipeline developed within the Rosetta CRUK Grand Challenge Consortium.

These datasets will be created for Head and Neck squamous cell carcinoma and endometrial cancer, as two exemplars where the envisioned technology can be deployed in a straightforward manner.

The resulting technology will be tested in animal models and human cadavers before obtaining ethical permission for human testing.

Within the framework of the current program, we are planning to conduct first-in-human experiments and clinical feasibility studies for both Head and Neck and Endometrial cancers.

We expect the technology to allow significantly better precision with regard to the removal of tumour and leaving healthy structures intact.

Furthermore, we expect to create a full map of tumour heterogeneity in the course of the intervention, which can inform the medical team about the best therapeutic options.