de Muynck Lysanne D A N, White Kevin P, Alseidi Adnan, Bannone Elisa, Boni Luigi, Bouvet Michael, Falconi Massimo, Fuchs Hans F, Ghadimi Michael, Gockel Ines, Hackert Thilo, Ishizawa Takeaki, Kang Chang Moo, Kokudo Norihiro, Nickel Felix, Partelli Stefano, Rangelova Elena, Swijnenburg Rutger Jan, Dip Fernando, Rosenthal Raul J, Vahrmeijer Alexander L, Mieog J Sven D
Department of Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.
ScienceRight Research Consulting, London, ON N6A 3S9, Canada.
Cancers (Basel). 2023 Jan 20;15(3):652. doi: 10.3390/cancers15030652.
Indocyanine green (ICG) is one of the only clinically approved near-infrared (NIR) fluorophores used during fluorescence-guided surgery (FGS), but it lacks tumor specificity for pancreatic ductal adenocarcinoma (PDAC). Several tumor-targeted fluorescent probes have been evaluated in PDAC patients, yet no uniformity or consensus exists among the surgical community on the current and future needs of FGS during PDAC surgery. In this first-published consensus report on FGS for PDAC, expert opinions were gathered on current use and future recommendations from surgeons' perspectives. A Delphi survey was conducted among international FGS experts via Google Forms. Experts were asked to anonymously vote on 76 statements, with ≥70% agreement considered consensus and ≥80% participation/statement considered vote robustness. Consensus was reached for 61/76 statements. All statements were considered robust. All experts agreed that FGS is safe with few drawbacks during PDAC surgery, but that it should not yet be implemented routinely for tumor identification due to a lack of PDAC-specific NIR tracers and insufficient evidence proving FGS's benefit over standard methods. However, aside from tumor imaging, surgeons suggest they would benefit from visualizing vasculature and surrounding anatomy with ICG during PDAC surgery. Future research could also benefit from identifying neuroendocrine tumors. More research focusing on standardization and combining tumor identification and vital-structure imaging would greatly improve FGS's use during PDAC surgery.
吲哚菁绿（ICG）是荧光引导手术（FGS）中唯一获得临床批准的近红外（NIR）荧光团之一，但它对胰腺导管腺癌（PDAC）缺乏肿瘤特异性。几种肿瘤靶向荧光探针已在PDAC患者中进行了评估，但手术界对于PDAC手术中FGS的当前和未来需求尚未达成统一意见或共识。在这份关于PDAC的FGS的首次发表的共识报告中，从外科医生的角度收集了关于当前使用情况和未来建议的专家意见。通过谷歌表单对国际FGS专家进行了德尔菲调查。专家们被要求对76条陈述进行匿名投票，≥70%的同意率被视为达成共识，≥80%的参与率/陈述被视为投票稳健性。76条陈述中有61条达成了共识。所有陈述都被认为是稳健的。所有专家都同意，FGS在PDAC手术中是安全的，缺点很少，但由于缺乏PDAC特异性的近红外示踪剂以及没有足够的证据证明FGS比标准方法更具优势，目前不应将其常规用于肿瘤识别。然而，除了肿瘤成像外，外科医生表示，在PDAC手术中使用ICG可视化血管和周围解剖结构会对他们有所帮助。未来的研究也可能从识别神经内分泌肿瘤中受益。更多关注标准化以及将肿瘤识别与重要结构成像相结合的研究将大大改善FGS在PDAC手术中的应用。
