The future of tumour-specific fluorescence-guided surgery for pancreatic cancer

A crucial issue in the surgical treatment of patients with pancreatic ductal adenocarcinoma is the absence of direct, real-time, intraoperative visualisation of the lesion and its metastases. An unacceptably high number of surgeries with curative intent for localised pancreatic ductal adenocarcinoma result in early locoregional recurrence, suggesting a weakness in our ability to completely remove the tumour at its resection bed and to recognise radiographically occult metastatic disease. There is a need for an agent to enhance the ability of surgeons to assess the tumour and metastases (if present), directly and in real-time. The ideal agent should be safe and cost-effective, with rapid pharmacokinetics and a high sensitivity and specificity to the tumour, lymph nodes, and metastases while sparing non-cancerous tissue. 1 Rosenthal EL Warram JM de Boer E et al. Successful translation of fluorescence navigation during oncologic surgery: a consensus report. J Nucl Med Off Publ Soc Nucl Med. 2016; 57: 144-150 Crossref PubMed Scopus (89) Google Scholar , 2 Pogue BW Rosenthal EL Achilefu S van Dam GM Perspective review of what is needed for molecular-specific fluorescence-guided surgery. J Biomed Opt. 2018; 23: 1-9 Google Scholar Tumour-specific fluorescence-guided surgery for pancreatic cancer using panitumumab-IRDye800CW: a phase 1 single-centre, open-label, single-arm, dose-escalation studyTo our knowledge, this study presents the first clinical use of panitumumab-IRDye800CW for detecting pancreatic ductal adenocarcinomas and shows that panitumumab-IRDye800CW is safe and feasible to use during pancreatic cancer surgery. Tumour-specific intraoperative imaging might have added value for treatment of patients with pancreatic ductal adenocarcinomas through improved patient selection and enhanced visualisation of surgical margins, metastatic lymph nodes, and distant metastasis. Full-Text PDF