Fluorescence Guided Surgery
Fluorescence Guided Surgery for Pediatric Oncology
Background
Tumor resection is one of the important pillars in the treatment of pediatric patients with solid tumors. Tumor resections remain often technically challenging due to the difficulty to distinguish visually and/or tactilely, between tumor and healthy surrounding tissue, and also because the tumor can encase blood vessels and nerves. Presence of positive resection margins which indicate residual tumor after resection, is a strong predictor of tumor recurrence and a worse prognosis.
In order to resect all tumor present, achieve negative resection margins and preserve healthy tissue, it is of great importance to accurately discriminate tumor from healthy tissue. Novel intra-operative imaging modalities have been developed to assist surgeons with the visual identification of tumor tissue. One of the most promising modalities is fluorescence-guided surgery (FGS), which makes use of near-infrared (NIR) fluorescence imaging. By injecting a fluorescent agent, tumor tissue can be visualized in real-time using a specific NIR-camera system.
Fluorescence Guided Surgery has several advantages when compared to other intra-operative detection methods. To start with, the maximum absorption (765nm) and peak fluorescence emission (830nm) wavelengths are in the NIR spectrum, which results in a depth penetration up to 10mm and reduced background fluorescence. This enables detection of tumor tissue even if it is covered by blood or a thin layer of tissue. In addition, fluorescent dyes make use of non-ionizing radiation (unlike intraoperative computed tomography or radio-active agents). Moreover, they are invisible to the naked eye and thus does not contaminate the surgical field nor results in long lasting tattoos. Finally, it is easy to use and does not interrupt the surgical workflow.
Aim
Aim
Perform pre-clinical and clinical studies in the field of Fluorescence Guided Surgery with the ultimate goal to improve care by implementing this promising technique in the Princess Máxima Center.
Project Outcomes
Jeremiasse B, van der Steeg AFW, Fiocco M, Hobbelink MGG, Merks JHM, Godzinski J, Shulkin BL, Wijnen MWHA, Terwisscha van Scheltinga CEJ (2021). The Value of the Sentinel Node Procedure in Pediatric Extremity Rhabdomyosarcoma: A Systematic Review and Retrospective Cohort Study. Ann Surg Oncol, 28:9048–9059. doi: 10.1245/s10434-021-10035-9
Jeremiasse B, van den Bosch CH, Wijnen MWHA, Terwisscha van Scheltinga CEJ, Fiocco MF, van der Steeg AFW (2020). Systematic review and meta-analysis concerning near-infrared imaging with fluorescent agents to identify the sentinel lymph node in oncology patients. Eur J Surg Oncol, 46(11):2011-2022. doi: 10.1016/j.ejso.2020.07.012
Team
Team
Prof. dr. M. Fiocco, Mathematical Institute Leiden University, Department of Biomedical Data Sciences Leiden University Medical Center & Princess Máxima Center for Pediatric Oncology
Drs. B. Jeremiasse, PhD candidate at the Princess Máxima Center for Pediatric Oncology
Dr. A. Rios, Principal Investigator and Imaging specialist, Princess Máxima Center for Pediatric Oncology
Dr. A.F.W. van der Steeg, Pediatric Surgeon at the Princess Máxima Center for Pediatric Oncology
Prof. dr. M.H.W.A. Wijnen, Pediatric Surgeon at the Princess Máxima Center for Pediatric Oncology