Translational Colorectal Research Laboratory

Our group is following several lines of enquiry in this field:

1) Cancer initiation and progression

• Definition of ‘driver and passenger’ mucosal bacteria that are implicated in the aetiology of bowel cancer.
• We are performing studies to determine how the microbiome regulates metastatic spread, through a collaboration with the Beatson institute.
• IBD cancers: Our research group is studying how the microbiome regulates cancer initiation through the microbial regulation of inflammatory cascades.

2) Cancer prevention

• We are working with collaborators to perform fibre intervention studies in high-risk indigenous populations in Alaska to modulate the microbiome for colorectal cancer prevention.

3) Engineering the microbiome for therapeutic benefit

• Bacteriocins – Through our collaboration with Prof. Chris Barnes at UCL, we are establishing novel candidates for targeting bacterial species implicated in the regulation of tumour response to chemoradiotherapy in rectal cancer.
• Faecal Microbiome Transplant (FMT): We are analysing data from clinical trials of FMT in patients with inflammatory bowel disease to determine how the microbiome drives disease regression.

4) Diet–microbiome interactions in colorectal disease

• We are studying how enteral feeding regulates the mucosal immune response in inflammatory bowel disease.
• Nutritional regulation of surgical outcomes in enhanced recovery and prehabilitation.

5) Surgical outcomes, anastomotic healing and intestinal failure

• We are funded by the EU Horizon 2020 programme to develop an international training network (ITN) for the analysis of the gut microbiome in anastomotic healing and colorectal surgical outcomes.
• Intestinal failure (IF) – we are mapping how the microbiome regulates the recovery of the gut in patients with short gut syndrome.

1) Intelligent Knife / iEndoscope

We have developed technology for the real time analysis of tissue during minimally invasive and endoscopic surgery through the chemical analysis of smoke plumes generated from surgical energy devices.

2) Cancer detection and early diagnosis – LA-REIMS

We are developing novel biomarkers for the detection of cancer and inflammatory bowel disease based on the real time detection of lipids from faecal samples using ambient mass spectrometry.

3) Colonic adenoma evolution

Our group is performing fundamental research to study how metabolism in colonic polyps (adenomas) drives cancer progression.

4) Cancer metastases

Through our collaboration with Prof. Trevor Graham at Barts Cancer Institute we are mapping the genetic changes and immune system changes that occur when stage IV cancer evolves to identify new therapeutic targets.

5) The developing gut (GROWTH)

The microbiome is increasingly implicated in the development of non-communicable diseases of the GI tract. We are studying the neonatal microbiome and its metabolic functions to determine how this causes diseases in adults.

1) Development of microbiome models for cancer research

We collaborate with Prof. Gary Frost and industrial partners to develop colorectal organoids that incorporate the microbiome that can be leveraged to develop personalised therapy for inflammatory bowel disease and cancer.

1) REDASA - NLP research

We have established novel “human in the loop” methodologies for managing the infodemic of surgical literature. This was based on pilot work carried out during COVID19. https://www.pansurg.org/redasa.

2) Autonomous assessment of surgical learning curves

We are working with Dr. Benny Lo to build new methodologies for the autonomous analysis of surgical performance during laparoscopic and robotic surgery.

3) Image augmentation (XR)

3D anatomical imaging. Our group is building new methods for performing image augmented precision surgery in cancer and trauma. Moreover, we are developing methods for surgical education and training that take advantage of cloud based holographic models.

4) Ethics and data governance

The application of AI in colorectal surgery presents new ethical and governance dilemmas which must be defined if this technology is to be safely applied.

1) Clinical robotic assessment and engineering of future robotic systems

We are developing endoluminal robotic systems with Dr. George Mylonas and our group assesses novel commercial robotic platforms for use in colorectal surgery.

2) Surgical sensors and imaging

The objective is to develop chemically driven, autonomous robotic systems that integrate sensors and real time analysis of cancer margins to improve the oncological outcome of endoluminal and minimally-invasive robotic surgery.

3) Radiomics

We are collaborating with Prof. Eric Aboagye to develop digital systems capable of automatically detecting the presence of cancer on CT / MRI scans, and of predicting survival and cure.

1) Characterisation of the mechanisms of continence

We are developing novel metrics for investigations such as high-resolution anorectal manometry to better characterise rectoanal sensorimotor function and understand the impacts of aging, structural disease and surgery with the goal of identifying physiological biomarkers that may be used for treatment targeting.

2) Standardisation of anorectal function testing

We are investigating the utility of investigations for physiological testing, validating existing physiological metrics and exploring the impact of test variability on decision making.

3) Phenotyping of GI symptom clusters

We are developing strategies to describe functional phenotypes through factor analysis of gastrointestinal symptoms.

4) Functional consequences of colorectal surgery

We are characterising functional consequences of surgery and investigating physiological features that may be of future use for functional pre- and rehabilitation.

5) Patient reported outcomes

We are performing studies to better understand the personal impact of bowel dysfunction with real-time symptom tracking and exploration of coping mechanisms.

1) Pressurised IntraPeritoneal Aerosolised Chemotherapy (PIPAC)

We have established a trial assessing the use of pressurised aerosolised oxaliplatin delivered by keyhole (laparoscopic surgery) for patients who have stage IV colorectal cancer peritoneal metastases.

2) IntraOperative RadioTherapy (IORT)

We are investigating the use of radiotherapy during surgery for patients with locally advanced rectal cancer.

3) High Intensity Focused Ultrasound (HIFU)

We are working with industry to develop ultrasound-based technology that can be used to treat locally advanced rectal cancer where radiotherapy or surgery are either not possible or have failed.

4) Decreasing cancer recurrence after surgery

Through our collaboration with Prof. Daqing Ma we are developing a clinical trial to investigate a randomised feasibility study evaluating the effect of perioperative intravenous lidocaine on colorectal cancer outcome after surgery.

5) Decreasing risk of anastomotic leak after colorectal surgery

Working with industry we are developing studies to decrease the risk of bowel joins not healing, which is a devastating problem that severely impacts on patient quality of life and may need a permanent bag (stoma).

6) Improving healing of anal fistulae

We are developing studies with industry to assess the role of autologous mesenchymal fat transfer as a potential treatment for anal fistula. It is hoped that this will result in a successful minimally invasive treatment that overcomes many of the limitations of current treatments such as incontinence.

7) iEndoscope

Intelligent endoscopic platform for the real time characterization of colonic polyps using in vivo mass spectrometry.

8) MECANO Trial

Commercially funded multicenter, prospective observational study for the development of blood based metabolic biomarkers for the early detection of CRC and complex adenomas.

9) TRACC Study

Tracking mutations in cell free tumour DNA to predict Relapse in eArly Colorectal Cancer (TRACC study). Chief Investigator: Prof. David Cunningham, Royal Marsden NHS Foundation trust.