Fluorescence-guided surgery in colorectal cancer; A review on clinical results and future perspectives

Abstract

Background: Colorectal cancer is the fourth most diagnosed malignancy worldwide and surgery is one of the cornerstones of the treatment strategy. Near-infrared (NIR) fluorescence imaging is a new and upcoming technique, which uses an NIR fluorescent agent combined with a specialised camera that can detect light in the NIR range. It aims for more precise surgery with improved oncological outcomes and a reduction in complications by improving discrimination between different structures. Methods: A systematic search was conducted in the Embase, Medline and Cochrane databases with search terms corresponding to 'fluorescence-guided surgery', 'colorectal surgery', and 'colorectal cancer' to identify all relevant trials. Results: The following clinical applications of fluorescence guided surgery for colorectal cancer were identified and discussed: (1) tumour imaging, (2) sentinel lymph node imaging, (3) imaging of distant metastases, (4) imaging of vital structures, (5) imaging of perfusion. Both experimental and FDA/EMA approved fluorescent agents are debated. Furthermore, promising future modalities are discussed. Conclusion: Fluorescence-guided surgery for colorectal cancer is a rapidly evolving field. The first studies show additional value of this technique regarding change in surgical management. Future trials should focus on patient related outcomes such as complication rates, disease free survival, and overall survival.

Can fluorescence-guided surgery improve optimal surgical treatment for ovarian cancer? A systematic scoping review of clinical studies

“…Although fluorescence-guided surgery has been used for other tumors, clinical research invariably lacks sufficient data on long-term clinical and oncologic outcomes 47 48. However, most available data are based on gastrointestinal and urological tumors not ovarian cancer.…”

Experimental study of the quantification of indocyanine green fluorescence in ischemic and non-ischemic anastomoses, using the SERGREEN software program

“…Another software available in the market for ICG fluorescence intensity quantification is Quest™. Quest medical imaging, from OLYMPUS® is a full medical device that includes the hardware (laparoscopic tower and light source with double channel for visible and infrared light) and the software (Spectrum 2.0®) 14 which is designed to give a value to the amount of infrared light that arrives to the camera. The principle behind this system is to traduce fluorescence intensity to a number of lumens that the camera detects from the tissue of interest.…”

Design, fabrication, and preclinical testing of a miniaturized, multispectral, chip-on-tip, imaging probe for intraluminal fluorescence imaging of the gastrointestinal tract

“…Fluorescence-guided surgery (FGS), in particular, has shown promise by significantly improving the visual contrast between normal and cancerous tissues to facilitate the complete resection of tumors which can reduce the likelihood of their recurrence (Gutowski et al, 2017;Meijer et al, 2021). As such, FGS demonstrates potential for effective localization, visual inspection, and complete surgical resection of tumors within the GI tract, and has previously shown success in delineating healthy tissues from those that are cancerous (Nagaya et al, 2017;Galema et al, 2022). By tagging specific biomarkers of cancer with exogenous fluorescent moieties, contrast can be induced between highly fluorescent, labeled cancerous tissue and minimally fluorescent normal tissue.…”