Fluorescence and image-guided surgery in colorectal cancer and its hepatic metastases

Abstract

Surgery remains the cornerstone of treatment for many cancers. However, intraoperative differentiation between vital structures, lymph nodes, tumor tissue, and surrounding healthy tissue, as well as between well- and poorly perfused tissue, can be challenging. Consequently, residual tumor tissue or poorly perfused tissue may remain, while vital structures may be inadvertently damaged.

Near-infrared (NIR) fluorescence imaging provides surgeons with real-time intraoperative information by enhancing the contrast between target and surrounding tissue. Studies have demonstrated that indocyanine green (ICG)-based NIR fluorescence imaging for assessing bowel perfusion during sigmoid and rectal resections reduce the risk of anastomotic leakage. Further standardization may needed to validate this technique and improve its reproducibility for widespread clinical implementation.

Novel fluorescent agents, such as ZW800-1, show promise for ureteral visualization. However, extensive safety evaluation is essential, as demonstrated by the severe cardiac toxicity observed with PanLN800(-Forte). Image segmentation of CT and MRI scans enables the creation of three-dimensional anatomical models, supporting preoperative planning, surgical navigation, and treatment evaluation. This approach shows promise for assessing ablation margins after thermal treatment of colorectal liver metastases. Finally, artificial intelligence may further enhance fluorescence-guided surgery by supporting intraoperative decision-making.