Page 192 - Fluorescence-guided cancer surgery

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Chapter 11
from a surgical resection, while no vital tumor tissue is present at pathological examination. On the contrary, these surgical resections are associated with morbidity and mortality, and safely avoiding such procedures would have a major impact on quality of life. This has resulted in a paradigm swift toward omitting surgery in patients with a complete clinical response and facilitating organ-preservation. Hereby it’s essential to select patients with a complete clinical response after neoadjuvant therapy and to monitor them. There are several studies reporting on this “Watch and Wait” policy in rectal cancer21, and an international database was recently established to monitor the results of this strategy22. Molecular imaging could have major impact on the selection and monitoring of a patient, because it could give more precise and objective information on the presence of vital tumor tissue in for example the scar tissue after chemo-radiation therapy.
CONCLUSIONS
Fluorescence-guided surgery has shown its potential in visualizing tumor tissue and increasing the number of detected malignant lesions that are otherwise undetectable. Besides, it assists in the identi cation of lymph nodes and vitals structures. Further studies, preferably randomized controlled trials, should validate whether improved tumor detection results in better patient outcomes by means of improved survival and reduced morbidity. Combined e orts in the rapidly expanding eld of uorescence-guided surgery hopefully leads to clinical implementation and determining its place in standard of care treatment of cancer patients in the near future.