Patients with colorectal cancer undergoing traditional resection deemed """"""""curative"""""""" by the surgeon have a one in three chance of developing recurrent disease. New approaches are needed to assist the surgeon in determining the extent of disease and guide post-operative follow-up and therapy. The objective of this pilot study is to determine the feasibility of 1) rigidly and non-rigidly registering positron emission tomography (PET) to computed tomography (CT) images and applying, this fused dataset to guide surgery with an image-guided navigation system and 2) implementing a handheld positron probe to facilitate detection and potentially improve resection of otherwise clinically occult disease. Preoperatively, patients with metastatic colorectal cancer will undergo traditional PET and CT scanning. Those found to have resectable disease limited to the abdomen would have their images combined using developed registration software (rigid and nonrigid). Immediately prior to the operation, each patient will be injected with fluorodeoxyglucose (FDG) and taken to the operating room for traditional exploration. An updated image of the abdomen will be acquired through the use of an intraoperative CT scan. The presurgical (high resolution) PET-CT fused dataset will be modified through registration with the intraoperative CT to account for anatomical shift and or warping. In order to facilitate the identification and more complete resection of lesions visible on PET-CT, a handheld positron probe will be used as the pointing device with the image-guided navigation system. Thus, the probe will be capable of providing course navigation to FDG-avid sites and providing real-time detection of lesions that may not be grossly visible. These areas will be resected when technically possible and safe. This study has two specific aims.
Aim 1 will determine the feasibility of using rigid registration and Aim 2, non-rigid registration.
| Kocak, Ergun; Al-Saif, Osama; Satter, Martin et al. (2007) Image guidance during abdominal exploration for recurrent colorectal cancer. Ann Surg Oncol 14:405-10 |
