title: Oncologic Procedures Amenable to Fluorescence-guided Surgery.
abstract: Although fluorescence imaging is being applied to a wide range of cancers, it remains unclear which disease populations will benefit greatest. Therefore, we review the potential of this technology to improve outcomes in surgical oncology with attention to the various surgical procedures while exploring trial endpoints that may be optimal for each tumor type.
  
  
  
  For many tumors, primary treatment is surgical resection with negative margins, which corresponds to improved survival and a reduction in subsequent adjuvant therapies. Despite unfavorable effect on patient outcomes, margin positivity rate has not changed significantly over the years. Thus, patients often experience high rates of re-excision, radical resections, and overtreatment. However, fluorescence-guided surgery (FGS) has brought forth new light by allowing detection of subclinical disease not readily visible with the naked eye.
  
  
  
  We performed a systematic review of clinicatrials.gov using search terms "fluorescence," "image-guided surgery," and "near-infrared imaging" to identify trials utilizing FGS for those received on or before May 2016.
  
  
  
  fluorescence surgery for tumor debulking, wide local excision, whole-organ resection, and peritoneal metastases.
  
  
  
  fluorescence in situ hybridization, fluorescence imaging for lymph node mapping, nonmalignant lesions, nonsurgical purposes, or image guidance without fluorescence.
  
  
  
  Initial search produced 844 entries, which was narrowed down to 68 trials. Review of literature and clinical trials identified 3 primary resection methods for utilizing FGS: (1) debulking, (2) wide local excision, and (3) whole organ excision.
  
  
  
  The use of FGS as a surgical guide enhancement has the potential to improve survival and quality of life outcomes for patients. And, as the number of clinical trials rise each year, it is apparent that FGS has great potential for a broad range of clinical applications.
authors.affiliation: *Department of Surgery, University of Alabama at Birmingham, Birmingham, AL †Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, AL ‡School of Medicine, University of Alabama at Birmingham, Birmingham, AL §School of Medicine, University Medical Center Groningen, Groningen, The Netherlands ¶Department of Surgery, Stanford University, Stanford, CA ||Department of Urology, Stanford University, Stanford, CA **Division of Surgical Oncology, Department of Surgery, University of California San Diego, La Jolla, CA ††Division of Orthopedic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL ‡‡Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands §§Department of Radiology, University of Alabama at Birmingham, Birmingham, AL ¶¶Department of Otolaryngology, Stanford University, Stanford, CA.
authors.forename: Kiranya E
authors.initials: KE
authors.lastname: Tipirneni
authors.forename: Jason M
authors.initials: JM
authors.lastname: Warram
authors.forename: Lindsay S
authors.initials: LS
authors.lastname: Moore
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Prince
authors.forename: Esther
authors.initials: E
authors.lastname: de Boer
authors.forename: Aditi H
authors.initials: AH
authors.lastname: Jani
authors.forename: Irene L
authors.initials: IL
authors.lastname: Wapnir
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Liao
authors.forename: Michael
authors.initials: M
authors.lastname: Bouvet
authors.forename: Nicole K
authors.initials: NK
authors.lastname: Behnke
authors.forename: Mary T
authors.initials: MT
authors.lastname: Hawn
authors.forename: George A
authors.initials: GA
authors.lastname: Poultsides
authors.forename: Alexander L
authors.initials: AL
authors.lastname: Vahrmeijer
authors.forename: William R
authors.initials: WR
authors.lastname: Carroll
authors.forename: Kurt R
authors.initials: KR
authors.lastname: Zinn
authors.forename: Eben
authors.initials: E
authors.lastname: Rosenthal
mesh_terms: D065426:Cytoreduction Surgical Procedures; D006801:Humans; D009369:Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D061848:Optical Imaging; D025321:Surgery, Computer-Assisted / Q000379:methods*