Kotb Ahmed, Hafeji Zaynab, Jesry Fadel, Lintern Nicole, Pathak Samir, Smith Andrew M, Lutchman Kishan R D, de Bruin Daniel M, Hurks Rob, Heger Michal, Khaled Yazan S
Leeds Institute of Medical Research, University of Leeds, Leeds LS2 9JT, UK.
The Pancreato-Biliary Unit, St James's University Teaching Hospital, Leeds LS9 7TF, UK.
Cancers (Basel). 2024 Nov 12;16(22):3803. doi: 10.3390/cancers16223803.
Surgical resection for pancreatic ductal adenocarcinoma (PDAC) entails the excision of the primary tumour and regional lymphadenectomy. This traditional strategy is challenged by the high rate of early recurrence, suggesting inadequate disease staging. Novel methods of intra-operative staging are needed to allow surgical resection to be tailored to the disease's biology.
A search of published articles on the PubMed and Embase databases was performed using the terms 'pancreas' OR 'pancreatic' AND 'intra-operative staging/detection' OR 'guided surgery'. Articles published between January 2000 and June 2023 were included. Technologies that offered intra-operative staging and tailored treatment were curated and summarised in the following integrative review.
lymph node (LN) mapping and radioimmunoguided surgery have shown promising results but lacked practicality to facilitate real-time intra-operative staging for PDAC. Fluorescence-guided surgery (FGS) offers high contrast and sensitivity, enabling the identification of cancerous tissue and positive LNs with improved precision following intravenous administration of a fluorescent agent. The unique properties of optical coherence tomography and ultrasound elastography lend themselves to be platforms for virtual biopsy intra-operatively.
Accurate intra-operative staging of PDAC, localisation of metastatic LNs, and identification of extra-pancreatic disease remain clinically unmet needs under current detection methods and staging standards. Tumour-specific FGS combined with other diagnostic and therapeutic modalities could improve tumour detection and staging in patients with PDAC.
胰腺导管腺癌（PDAC）的手术切除需要切除原发肿瘤并进行区域淋巴结清扫。这种传统策略受到早期复发率高的挑战，提示疾病分期不足。需要新的术中分期方法，以使手术切除能够根据疾病生物学特性进行调整。
使用“胰腺”或“胰腺的”以及“术中分期/检测”或“引导手术”等术语在PubMed和Embase数据库中检索已发表的文章。纳入2000年1月至2023年6月发表的文章。在以下综合综述中对提供术中分期和个性化治疗的技术进行了整理和总结。
淋巴结（LN） mapping和放射免疫引导手术已显示出有前景的结果，但缺乏促进PDAC实时术中分期的实用性。荧光引导手术（FGS）具有高对比度和高灵敏度，在静脉注射荧光剂后能够更精确地识别癌组织和阳性LN。光学相干断层扫描和超声弹性成像的独特特性使其适合作为术中虚拟活检的平台。
在当前的检测方法和分期标准下，PDAC准确的术中分期、转移性LN的定位以及胰腺外疾病的识别在临床上仍未得到满足。肿瘤特异性FGS与其他诊断和治疗方式相结合可以改善PDAC患者的肿瘤检测和分期。
