Molecular Fluorescence Guided Surgery of Peritoneal Metastasis: From bench to bedside

Optimal cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is essential for potential curative treatment of peritoneal carcinomatosis of colorectal origin. Although after the introduction of this treatment the survival has increased substantially, there is still a recurrence rate of more then 50% within the first year. At present, surgeons depend on visual inspection and palpation alone for intraoperative tumor detection. One of the theories for the recurrence rate is that the surgeon unintentionally left tumor tissue behind that was not detected otherwise by visual or tactile inspection.
This thesis describes the developments of Molecular fluorescence-guided surgery (MFGS). By using a targeted fluorescent tracer, in combination with a highly sensitive optical camera system, peritoneal metastasis can be visualized. This method was first evaluated in small animal models and finally resulted in an early phase small clinical trial in patients with peritoneal metastasis from colorectal origin. This study showed that fluorescent imaging gives the surgeon potentially a real-time tool for intraoperative decision-making. The results indicate that this technique could prevent both undertreatment (i.e. incomplete detection of malignant lesions) and overtreatment (non-malignant lesions that do not require resection).
A subsequent phase 2 trial will be initiated based on the results of this thesis to make a definitive assessment of the diagnostic accuracy and the effect on clinical decision making of molecular fluorescence-guided surgery in patients with peritoneal metastasis.