Fluorescence imaging in pancreatic cancer surgery. (A systematic review)

Improved surgical outcomes in patients with pancreatic cancer are largely associated with atraumatic and precise surgical technique. In this context, the most accurate determination of tumor localization, size, and metastases is particularly important. This can be achieved through fluorescence imaging (FI). It allows not only for specifying the localization of tumor foci and mapping lymphatic collectors, but also for a fairly accurate assessment of organ and tissue perfusion. Objective. Systematic review aims to determine the feasibility of using FI in pancreatic surgery (PROSPERO ID: CRD42023475963). Material and methods. The literature search was conducted using the MEDLINE, Embase, and e-Library databases from 31 of October, 2023 y., to 30 of June, 2024 y. This systematic review included all studies describing the use of FI during pancreatic surgery. Results. A total of 383 patients from 32 studies meeting the inclusion criteria were included in the review. The most commonly used fluorescent agent was indocyanine green (ICG), utilized in 28 studies. The authors cite the following important advantages of FI: more accurate determination of tumor and metastatic lesion localization, reliable assessment of organ blood supply and viability before and after resection, and a reduction in the risk of intraoperative injury to the common bile duct during pancreatic surgical interventions. Conclusion. FI in pancreatic surgery has a definite potential for detecting metastatic lesions not identified by radiological imaging methods, providing more precise visualization of tumors and resection margins, reducing the risk of intraoperative complications, and enabling reliable assessment of perfusion and viability of the pancreas, stomach, duodenum, spleen, and liver. This method may also be used to evaluate the effectiveness of neoadjuvant therapy in patients with pancreatic cancer.