Precise Tumor Resection Research Articles

Innovative approaches to cage reconstructions in orthopedic limb surgery: Advances and insights with two cases

BackgroundLimb tumors, though rare, pose significant challenges to surgical management due to their impact on limb function and quality of life. Effective treatment requires precise tumor resection alongside advanced reconstructive techniques to restore limb function, particularly in cases of compromised bone healing. Titanium cages, traditionally used in spinal surgeries, have recently gained attention for their potential in limb reconstruction within orthopedic oncology, offering a novel approach to managing complex bone defects. Case PresentationThis retrospective case series presents two patients treated with titanium cages for limb reconstruction following tumor resection.Case 1: A 53-year-old female with a solitary plasmacytoma of the femur experienced a pathological fracture and nonunion after initial treatment. A titanium cage was employed to bridge the resected bone segment, leading to successful callus formation at the six-month follow-up and restored limb function.Case 2: A 31-year-old female with a giant cell tumor and hemangioma of the foot underwent en bloc resection followed by reconstruction using a vertebral cage and iliac corticospongious graft. Six months postoperatively, the patient had resumed full weight-bearing with no complications. ConclusionTitanium cages offer a promising solution for limb reconstruction in patients with tumors, particularly for large bone defects where traditional methods may be inadequate. This case series demonstrates successful outcomes in limb preservation and functional recovery using titanium cages. Their use in the adult population shows potential for broader application in orthopedic oncology, warranting further clinical investigation.

A Green Lantern for the Surgeon: A Review on the Use of Indocyanine Green (ICG) in Minimally Invasive Surgery.

Indocyanine green (ICG) fluorescence imaging has revolutionized surgical practice across various medical and surgical specialties. This article reviews the clinical applications of ICG in abdominal, urological, thoracic, and gynecological surgery. ICG fluorescence imaging has been widely adopted in general surgery for various applications, including perfusion assessment, intraoperative visualization of the ureter, and tumor localization. It is particularly valuable in evaluating anastomotic leaks and aiding in precise tumor resection during minimally invasive surgeries. Studies have shown mixed results on its effectiveness in reducing anastomotic leak rates, highlighting the need for further research. In thoracic surgery, ICG facilitates the identification and resection of pulmonary bullae, as well as the precise localization of pulmonary nodules during video-assisted surgery. In urology, ICG aids in localizing renal tumors and guiding selective arterial occlusion during partial nephrectomy. Its role in identifying the lymphatic pathway in prostate cancer and sentinel lymph node biopsy in gynecological cancer is also discussed. Despite its benefits, the use of ICG fluorescence faces challenges such as limited tissue penetration, the potential for false results, a lack of standardized protocols, and high equipment costs. Nonetheless, it remains a powerful tool that could improve surgical outcomes.

Confocal Laser Endomicroscopy in Resection of Sinonasal Malignant Melanoma-Preliminary Report on Real-Time Margin Assessment and Support in Surgical Decision-Making.

Background/Objectives: Building upon the rising value of Confocal Laser Endomicroscopy (CLE) in squamous cell carcinoma of the head and neck, we present the first application of CLE during the resection of sinonasal malignant melanomas. This study aims to evaluate the potential of CLE to assist surgeons in intraoperative decision-making, with a particular focus on resection margin assessment within the constrained nasal cavity. Methods: Two cases of sinonasal malignant melanoma were included in this study. CLE was employed to examine visible tumors and their margins, both pre- and post-endoscopic resection. The findings were compared to histopathological results as well as data on squamous cell carcinoma, for which malignancy criteria had already been established in prior projects. Results: CLE provided the real-time visualization of sinonasal malignant melanomas and their margins, successfully differentiating between healthy and neoplastic tissue compared to histopathological findings. Conclusion: CLE offers the potential for real-time assessment, aiding surgeons in more precise tumor resection and potentially improving patient outcomes. This study demonstrates the feasibility of using CLE in the resection of sinonasal malignant melanoma, highlighting its ability to differentiate between healthy and neoplastic tissue intraoperatively.

Efficacy and Safety of Obturator Nerve Block in Transurethral Resection of Bladder Tumors: A Comprehensive Review.

Transurethral resection of bladder tumors (TURBT) is a pivotal procedure in the management of bladder cancer, essential for both diagnosis and treatment. Effective anesthesia is crucial in TURBT to ensure a stable and pain-free operative field, facilitate precise tumor resection, and minimize complications such as the obturator reflex, which can lead to involuntary leg movement and bladder injury. The obturator nerve block (ONB) is a regional anesthesia technique designed to prevent the obturator reflex by blocking the obturator nerve, which innervates the adductor muscles of the thigh. This comprehensive review evaluates the efficacy and safety of ONB in TURBT. It begins by discussing the anatomical and physiological aspects of the obturator nerve, followed by a detailed examination of various ONB techniques, including ultrasound-guided and landmark-based methods. The review assesses the impact of ONB on pain management, reduction of adductor muscle spasms, and overall improvement in surgical conditions and patient satisfaction. Additionally, it explores the incidence and types of complications associated with ONB, such as hematoma, nerve injury, and local anesthetic systemic toxicity (LAST). It compares ONB with other anesthesia techniques used in TURBT, such as general, spinal, and epidural anesthesia. A critical analysis of key clinical studies and meta-analyses is presented to provide a comprehensive understanding of the current evidence on ONB efficacy and safety. Future directions and innovations in ONB techniques, including advances in imaging and nerve localization, are also discussed. Practical recommendations for implementing ONB in clinical practice, including guidelines for clinician training and patient selection criteria, are provided. This review aims to inform clinicians about the benefits and risks of ONB in TURBT, guide clinical practice, and identify areas for future research to optimize anesthesia management in bladder cancer surgery.

Role of TORS as De-Escalation Strategy in HPV-Related Oropharyngeal Cancer, What We Need to Know.

Human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) presents unique challenges and opportunities for treatment, particularly regarding de-escalation strategies to reduce treatment morbidity without compromising oncological outcomes. This paper examines the role of Transoral Robotic Surgery (TORS) as a de-escalation strategy in managing HPV-related OPSCC. We conducted a comprehensive literature review from January 2010 to June 2023, focusing on studies exploring TORS outcomes in patients with HPV-positive OPSCC. These findings highlight TORS's potential to reduce the need for adjuvant therapy, thereby minimizing treatment-related side effects while maintaining high rates of oncological control. TORS offers advantages such as precise tumor resection and the ability to obtain accurate pathological staging, which can guide the tailoring of adjuvant treatments. Some clinical trials provide evidence supporting the use of TORS in specific patient populations. The MC1273 trial demonstrated promising outcomes with lower doses of adjuvant radiotherapy (RT) following TORS, showing high locoregional tumor control rates and favorable survival outcomes with minimal side effects. ECOG 3311 evaluated upfront TORS followed by histopathologically directed adjuvant therapy, revealing good oncological and functional outcomes, particularly in intermediate-risk patients. The SIRS trial emphasized the benefits of upfront surgery with neck dissection followed by de-escalated RT in patients with favorable survival and excellent functional outcomes. At the same time, the PATHOS trial examined the impact of risk-adapted adjuvant treatment on functional outcomes and survival. The ongoing ADEPT trial investigates reduced-dose adjuvant RT, and the DART-HPV study aims to compare standard adjuvant chemoradiotherapy (CRT) with a reduced dose of adjuvant RT in HPV-positive OPSCC patients. These trials collectively underscore the potential of TORS in facilitating treatment de-escalation while maintaining favorable oncological and functional outcomes in selected patients with HPV-related OPSCC. The aim of this scoping review is to discuss the challenges of risk stratification, the importance of HPV status determination, and the implications of smoking on treatment outcomes. It also explores the evolving criteria for adjuvant therapy following TORS, focusing on reducing radiation dosage and volume without compromising treatment efficacy. In conclusion, TORS emerges as a viable upfront treatment option for carefully selected patients with HPV-positive OPSCC, offering a pathway toward treatment de-escalation. However, selecting the optimal candidate for TORS-based de-escalation strategies is crucial to fully leverage the benefits of treatment de-intensification.

Application of Epithelial Growth Factor Receptor-Targeted Magnetic Resonance Imaging and Near-Infrared II Dual-Modal Probe in Lung Cancer Diagnosis and Surgical Resection.

There has been an increase in the use of molecular probe diagnostic techniques for lung cancer, and magnetic resonance imaging (MRI) offers specific advantages for diagnosing pulmonary carcinoma. Furthermore, advancements in near-infrared II (NIR-II) fluorescence have provided a new method for precise intraoperative tumor resection. However, few probes combine preoperative diagnosis with intraoperative imaging. This study aims to fill this research void by employing a dual-modal probe that targets the epidermal growth factor receptor for MR and NIR-II imaging, enabling the preoperative diagnosis of lung cancer using MRI and precise intraoperative tumor localization using NIR-II with a single probe. The imaging effects and targeting ability of the probe were confirmed in cell lines, mouse models, and clinical samples. The MR signal decreased within 24 h in the patient-derived xenograft mouse model. The average signal-to-background ratio of NIR-II reached 3.98 ± 0.27. The clinical sample also showed a decrease in the T2 signal using MRI, and the NIR-II optical signal-to-background ratio was 3.29. It is expected that this probe can improve the diagnostic rate of lung cancer using MRI and enable precise intraoperative tumor resection using NIR-II.

Rational Design of NIR-II G-Quadruplex Fluorescent Probes for Accurate In Vivo Tumor Metastasis Imaging.

Accurate in vivo imaging of G-quadruplexes (G4) is critical for understanding the emergence and progression of G4-associated diseases like cancer. However, existing in vivo G4 fluorescent probes primarily operate within the near-infrared region (NIR-I), which limits their application accuracy due to the short emission wavelength. The transition to second near-infrared (NIR-II) fluorescent imaging has been of significant interest, as it offers reduced autofluorescence and deeper tissue penetration, thereby facilitating more accurate in vivo imaging. Nonetheless, the advancement of NIR-II G4 probes has been impeded by the absence of effective probe design strategies. Herein, through a "step-by-step" rational design approach, we have successfully developed NIRG-2, the first small-molecule fluorescent probe with NIR-II emission tailored for in vivo G4 detection. Molecular docking calculations reveal that NIRG-2 forms stable hydrogen bonds and strong π-π interactions with G4 structures, which effectively inhibit twisted intramolecular charge transfer (TICT) and, thereby, selectively illuminate G4 structures. Due to its NIR-II emission (940 nm), large Stokes shift (90 nm), and high selectivity, NIRG-2 offers up to 47-fold fluorescence enhancement and a tissue imaging depth of 5 mm for in vivo G4 detection, significantly outperforming existing G4 probes. Utilizing NIRG-2, we have, for the first time, achieved high-contrast visualization of tumor metastasis through lymph nodes and precise tumor resection. Furthermore, NIRG-2 proves to be highly effective and reliable in evaluating surgical and drug treatment efficacy in cancer lymphatic metastasis models. We are optimistic that this study not only provides a crucial molecular tool for an in-depth understanding of G4-related diseases in vivo but also marks a promising strategy for the development of clinical NIR-II G4-activated probes.

Intraoperative tumor mapping using pyridine-carbazole based multifunctional fluorescent probes for precise resection and photodynamic therapeutics

Precise intraoperative tumor localization plays a pivotal role in the quest for refined cancer therapeutics. Addressing this, we have developed a series of novel pyridine-carbazole-based probes (Mito-Pyca1 ∼ Mito-Pyca4) featuring viscosity-enhanced fluorescence and multiphoton absorption properties. Among them, Mito-Pyca4 showcases significant promise for two-photon activated photodynamic therapy. When subjected to near-infrared irradiation, it reliably produces copious singlet oxygen, crucial for targeted tumor treatment. In vitro and in vivo experiments validated the capacity of Mito-Pyca4 to effectively induce cell apoptosis and impede tumor growth with minimal toxicity, positioning it as a potential candidate for photodynamic therapy. Furthermore, the specificity of Mito-Pyca4 for cancer cells was confirmed in co-culture experiments, and the probe was utilized for in vivo fluorescence-guided surgery. Successfully distinguishing tumor tissue from normal tissue, Mito-Pyca4 facilitates precise tumor resection. In summary, this comprehensive study establishes Mito-Pyca4 as a versatile tool for nonlinear optical imaging, viscosity sensing, and fluorescence-guided cancer surgery and treatment, providing surgeons an unparalleled advantage in discerning tumor margins. Through this research, we underscore the transformative potential of integrating chemical innovation with surgical and therapeutic techniques.

Use of artificial intelligence in breast surgery: a narrative review.

We have witnessed tremendous advances in artificial intelligence (AI) technologies. Breast surgery, a subspecialty of general surgery, has notably benefited from AI technologies. This review aims to evaluate how AI has been integrated into breast surgery practices, to assess its effectiveness in improving surgical outcomes and operational efficiency, and to identify potential areas for future research and application. Two authors independently conducted a comprehensive search of PubMed, Google Scholar, EMBASE, and Cochrane CENTRAL databases from January 1, 1950, to September 4, 2023, employing keywords pertinent to AI in conjunction with breast surgery or cancer. The search focused on English language publications, where relevance was determined through meticulous screening of titles, abstracts, and full-texts, followed by an additional review of references within these articles. The review covered a range of studies illustrating the applications of AI in breast surgery encompassing lesion diagnosis to postoperative follow-up. Publications focusing specifically on breast reconstruction were excluded. AI models have preoperative, intraoperative, and postoperative applications in the field of breast surgery. Using breast imaging scans and patient data, AI models have been designed to predict the risk of breast cancer and determine the need for breast cancer surgery. In addition, using breast imaging scans and histopathological slides, models were used for detecting, classifying, segmenting, grading, and staging breast tumors. Preoperative applications included patient education and the display of expected aesthetic outcomes. Models were also designed to provide intraoperative assistance for precise tumor resection and margin status assessment. As well, AI was used to predict postoperative complications, survival, and cancer recurrence. Extra research is required to move AI models from the experimental stage to actual implementation in healthcare. With the rapid evolution of AI, further applications are expected in the coming years including direct performance of breast surgery. Breast surgeons should be updated with the advances in AI applications in breast surgery to provide the best care for their patients.

TriFNet: A triple-branch feature fusion network for pH determination by surface-enhanced Raman spectroscopy

Due to the acidic tumor microenvironment caused by metabolic changes in tumor cells, the accurate pH detection of extracellular fluid is helpful for doctors in precise tumor resection. The combination of Raman spectroscopy and deep learning provides a solution for pH detection. However, most existing studies use one-dimensional convolutional neural networks (1D-CNNs) for spectral analysis, which limits the performance due to insufficient feature extraction. In this work, we propose a 2D triple-branch feature fusion network (TriFNet) for accurate pH determination using surface-enhanced Raman spectra (SERS). Specifically, we design a triple-branch network structure by converting Raman spectra into three types of images to extensively extract complex patterns in spectra. In addition, an attention fusion module, which leverages the complementarity among features in both space and channel, is designed to obtain the valuable information, achieving further accurate pH determination. On our Raman spectral dataset containing 14,137 samples, we achieved mean absolute error (MAE) of 0.059, standard deviation of the absolute error (SD) of 0.07, root mean squared error (RMSE) of 0.092, and coefficient of determination (R2) of 0.991 on the test set. Compared with other published methods, the four metrics showed an average improvement of 47%, 39%, 43%, and 6%, respectively. In addition, visualization validates the diagnostic capability of our model to correlate with biomolecular signatures. Meanwhile, our model has robustness to different SERS chips. These results prove the potential of our method to develop an effective technology based on Raman spectroscopy for accurate pH determination to guide surgery.

Robotic enucleation of pancreatic insulinoma

We demonstrate robot-assisted treatment of a patient with benign pancreatic insulinoma. A 31-year-old patient suffered from attacks of weakness, numbness of the fingertips and «turbidity of consciousness» for 2 years. These symptoms occurred on an empty stomach and regressed after eating. We found pancreatic insulinoma. The patient underwent robotic enucleation of pancreatic tumor. Surgery time was 145 min. Postoperative period proceeded without complications. Hyperglycemia up to 10.5 mmol/l on the first postoperative day was followed by normalization after 4 days. The patient was discharged in 6 days after surgery. Minimally invasive robotic enucleation of insulinoma minimizes surgical trauma and provides precise resection of tumor. The key aspect of safe enucleation is localization of tumor at a distance of at least 2 mm from the pancreatic duct.

Inferior vena cava hemangioma resected using a novel Toumai robotic surgical platform

This study aims to investigate the significance of using the Toumai robotic platform for the resection of inferior vena cava (IVC) hemangiomas. Our objective is to provide information on the potential benefits of this innovative approach in managing these uncommon vascular tumors and to contribute to the growing body of knowledge in the field of surgical oncology and vascular surgery. A 37-year-old female patient with an incidental finding of a right retroperitoneal mass underwent contrast-enhanced magnetic resonance imaging, which confirmed the diagnosis of an IVC hemangioma. Due to the rarity and complexity of this vascular tumor, the medical team opted for a novel approach using the Toumai robotic surgical platform (Shanghai MicroPort MedBot Group Co, Ltd). Under general anesthesia, the patient was placed in the left lateral decubitus position, and the robotic arms were controlled remotely through the Toumai platform. A transperitoneal approach was adopted, and the surgeon meticulously resected the tumor while preserving the integrity of the IVC. The use of the Toumai robotic platform facilitated precise tumor resection, minimizing the risk of damage to surrounding structures. The minimally invasive nature of the robotic surgery contributed to a reduced incidence of postoperative complications and accelerated patient recovery. Furthermore, the remote fifth-generation mobile network surgical capabilities of the Toumai platform allow for expert care to be provided to patients despite geographic barriers. The robotic-assisted surgical approach using the Toumai platform demonstrates its potential benefits in managing rare and complex vascular tumors such as IVC hemangiomas. Robotic technology has the potential to revolutionize the field of surgical oncology and vascular surgery, leading to improved patient outcomes and healthcare delivery. However, more extensive clinical studies and larger case series are needed to validate the long-term safety and efficacy of this innovative surgical approach. Continued research and collaboration between clinicians and robotic technology experts are essential to fully realize the potential of robotic-assisted surgery for the benefit of patients with rare and challenging medical conditions.

Recent advances in head and neck surgical oncology.

In recent years, the field of head and neck oncology has witnessed a remarkable transformation with unprecedented advances that have revolutionized the management of complex tumors in this region. As an intricate subspecialty within oncology, head and neck surgical procedures demand detailed knowledge of the complex anatomy meticulous precision in surgical technique, and expertise to preserve vital functions while ensuring optimal oncological outcomes. With the relentless pursuit of improved patient outcomes, the integration of innovative technologies has significantly enhanced the surgical armamentarium. Robotics, endoscopic platforms, and image-guided navigation have revolutionized the surgical approach, enabling precise tumor resection and sparing healthy tissues. Furthermore, the application of advanced imaging modalities and molecular biomarker profiling has opened new avenues for personalized treatment strategies. From targeted therapies and immunotherapies to adaptive radiation techniques, clinicians are now equipped with an array of tailored options, ushering in a new era of personalized care for patients with head and neck malignancies. This article delves into the unfolding narratives of clinical triumphs, exploring the transformative potential of emerging therapies and the collaborative efforts propelling head and neck surgical oncology toward a future of hope and healing.

The GEM-handle as convenient labeling strategy for bimodal single-domain antibody-based tracers carrying 99mTc and a near-infrared fluorescent dye for intra-operative decision-making.

Intra-operative fluorescence imaging has demonstrated its ability to improve tumor lesion identification. However, the limited tissue penetration of the fluorescent signals hinders the detection of deep-lying or occult lesions. Integrating fluorescence imaging with SPECT and/or intra-operative gamma-probing synergistically combines the deep tissue penetration of gamma rays for tumor localization with the precision of fluorescence imaging for precise tumor resection. In this study, we detail the use of a genetically encoded multifunctional handle, henceforth referred to as a GEM-handle, for the development of fluorescent/radioactive bimodal single-domain antibody (sdAb)-based tracers. A sdAb that targets the urokinase plasminogen activator receptor (uPAR) was engineered to carry a GEM-handle containing a carboxy-terminal hexahistidine-tag and cysteine-tag. A two-step labeling strategy was optimized and applied to site-specifically label IRDye800CW and 99mTc to the sdAb. Bimodal labeling of the sdAbs proved straightforward and successful. 99mTc activity was however restricted to 18.5 MBq per nmol fluorescently-labeled sdAb to prevent radiobleaching of IRDye800CW without impeding SPECT/CT imaging. Subsequently, the in vivo biodistribution and tumor-targeting capacity of the bimodal tracer were evaluated in uPAR-positive tumor-bearing mice using SPECT/CT and fluorescence imaging. The bimodal sdAb showed expected renal background signals due to tracer clearance, along with slightly elevated non-specific liver signals. Four hours post-injection, both SPECT/CT and fluorescent images achieved satisfactory tumor uptake and contrast, with significantly higher values observed for the anti-uPAR bimodal sdAb compared to a control non-targeting sdAb. In conclusion, the GEM-handle is a convenient method for designing and producing bimodal sdAb-based tracers with adequate in vivo characteristics.

Three-dimensional digital technology-assisted precise tumor resection and reconstruction of the femoral trochanter and postoperative functional recovery: a retrospective study

BackgroundThe trochanter of the femur is a common site for bone tumors. However, locating the specific boundary of bone tumor infiltration and determining the surgical method can be challenging. The objective of this study was to review the diagnosis, treatment, and surgical outcomes of patients with tumors or tumor-like changes in the femoral trochanter after computer-assisted precise tumor resection and hip-preserving reconstruction of the trochanter. MethodsFrom January 2005 to September 2020, 11 patients with trochanteric tumors (aged: 18–53 years; six males and five females) were treated in Guangzhou First People's Hospital. The cases included aneurysmal bone cyst (n = 1), giant cell tumor of bone (n = 2), fibrous histiocytoma of bone (n = 1), endochondroma (n = 1), and fibrous dysplasia of bone (n = 6). For patients with trochanteric tumors, computed tomography and magnetic resonance imaging scanning were performed before operation to obtain two-dimensional image data of the lesion. A three-dimensional digital model of bilateral lower limbs was reconstructed by computer technology, the boundary of tumor growth was determined by computer simulation, the process of tumor resection and reconstruction was simulated, and the personalized guide template was designed. During the operation, the personalized guide plate guided the precise resection of the tumor, and the allogeneic bone was trimmed to match the shape of the bone defect. ResultsAll 11 patients underwent accurate resection of the tumor or tumor-like lesion and reconstruction of the hip. In eight cases, the lesion was confined to the trochanter, which was fixed with large segment allogeneic bone, autologous iliac bone, and proximal femoral anatomic plate. In three cases, allogeneic bone, autologous iliac bone, and femoral reconstruction nail were used to fix the tumor under the trochanter. Postoperative X-ray examination showed that the repair and reconstruction of the bone defect was effective, and callus bridging between the allogenic bone and autogenous bone was observed 6 months after operation. All patients recovered their walking function 3–6 months after operation. The duration of the follow-up period ranged from 6 months to 6 years. A patient experienced recurrence of endochondroma; pathological examination revealed chondrocytic sarcoma. The remaining 10 patients were treated with segmental resection and reconstruction. The operation time ranged 2.5–4.5 h (average: 3.2 h). Intraoperative blood loss ranged from 300 to 500 ml (average: 368 ml). The local recurrence rate was 9.1%, and the overall survival rate was 100%. The average Musculoskeletal Tumor Society score was 27 (excellent and good for eight and three patients, respectively). ConclusionsThree-dimensional computer skeleton modeling and simulation-assisted resection and reconstruction of femoral trochanteric tumor is a new surgical technique, which might markedly improve the surgical effect, shorten the surgical time, increase the overall survival rate of patients with tumors, reduce the local recurrence rate, assist in the digitization and programming of femoral trochanteric tumor surgery, and improve surgical accuracy.

Super‐stable homogeneous embolic agents advance the treatment of hepatocellular carcinoma

Super‐stable homogeneous embolic agents advance the treatment of hepatocellular carcinoma

In situ orderly self-assembly strategy affording NIR-II-J-aggregates for in vivo imaging and surgical navigation

J-aggregation, an effective strategy to extend wavelength, has been considered as a promising method for constructing NIR-II fluorophores. However, due to weak intermolecular interactions, conventional J-aggregates are easily decomposed into monomers in the biological environment. Although adding external carriers could help conventional J-aggregates stabilize, such methods still suffer from high-concentration dependence and are unsuitable for activatable probes design. Besides, these carriers-assisted nanoparticles are risky of disassembly in lipophilic environment. Herein, by fusing the precipitated dye (HPQ) which has orderly self-assembly structure, onto simple hemi-cyanine conjugated system, we construct a series of activatable, high-stability NIR-II-J-aggregates which overcome conventional J-aggregates carrier’s dependence and could in situ self-assembly in vivo. Further, we employ the NIR-II-J-aggregates probe HPQ-Zzh-B to achieve the long-term in situ imaging of tumor and precise tumor resection by NIR-II imaging navigation for reducing lung metastasis. We believe this strategy will advance the development of controllable NIR-II-J-aggregates and precise bioimaging in vivo.

Precise tumor resection under the navigation of Tumor-Microenvironment pH-activated NIR-II fluorescence imaging via calcium Carbonate/Polydopamine Co-packed Nd-doped downshifting nanoprobes

Photobleaching resistance, high quantum yield and deep tissue imaging of Nd-doped nanocrystals with fluorescence in the second near infrared region (NIR-II, 1000–1700 nm) occupied an indispensable position for precisely navigating tumor resection. However, these NIR-II nanoprobes often encounter high passive accumulation in reticuloendothelial system (RES) organs that attenuates signal to background ratio (SBR), resulting in the impediment of their application for accurate tumor outline delineation. Herein, a hollow-structured CaCO3 and polydopamine co-packed shell has been co-cladded on the Nd-doped down-shifting nanocrystals (DSNCs@hPCa). After conjugating folic acid molecules on the hollowed surface (DSNCs@hPCa-FA), this fascinating NIR-II contrast nanoagent can further specifically enhance tumor targeting capacity and gratifyingly restrain the NIR-II fluorescence in the “OFF” state. It sensitively responds to the weak acid tumor microenvironment, consequently, the hybrid nanoshell is degraded and the NIR-II fluorescence is efficiently turn “ON”. Robust fluorescent imaging with the augmented SBR has been demonstrated to accurately identify tumor borderlines from normal tissue. Tumors were thoroughly removed under the navigation of this novel pH stimuli-responsive NIR-II fluorescence imaging with ignorable in situ recurrence or metastases after 28 days post-surgery. This strategy indicates the preclinical potential of tumor microenvironment activated nanoprobes for assisting the accurate delineation of tumor margins.

Endoscopic ultrasound-guided injection of carbon nanoparticles suspension to label rectal cancer before neoadjuvant chemoradiotherapy: a retrospective cohort study.

Localization of the primary tumor and ensuring safe distal surgical margins (DSMs) following neoadjuvant chemoradiotherapy (nCRT) are challenging in locally advanced rectal cancers (LARCs). This study investigated the effectiveness of carbon nanoparticles suspension (CNS) for labeling the primary tumor and allowing precise tumor resection after nCRT. Clinicopathological data of LARC patients who underwent nCRT followed by laparoscopic radical anal preservation surgery at our center between January 2018 and February 2023 were prospectively collected. The patients were divided into the CNS tattooed (CNS) and non-tattooed (control) groups. In the CNS group, CNS was injected in four quadrants on the anal side 1 cm away from the lower tumor margin. DSMs were determined through intraoperative distal rectal examination in the control group and observation of CNS tattoos in the CNS group. DSM lengths and positive DSM rates were compared between the two groups to analyse the feasibility and effectiveness of CNS for labeling LARCs before nCRT. There was no statistically significant difference in the basic demographic data, effectiveness of nCRT, or post-operative recovery rates between the two groups (all P > 0.05). In the CNS group, CNS tattoos were observed on the outside of the rectal wall, with an overall efficiency of 87.1% (27/31). The CNS group had fewer positive DSMs and safer DSM lengths (2.73 ± 0.88 vs 2.12 ± 1.15 cm, P = 0.012) than the control group (P < 0.05). Endoscopic ultrasound-guided injection of CNS tattoos before nCRT could effectively label the LARCs, ensuring safe DSMs during anus-preserving surgeries (Chictr.org.cn No.: ChiCTR2300068991).

Functionalized polydopamine nanospheres as in situ spray for photothermal image-guided tumor precise surgical resection

Surgical resection is a critical procedure for treatment of solid tumor, which commonly suffers from postoperative local recurrence due to the possibility of positive surgical margin. Although the widely used clinical imaging techniques (CT, MRI, PET, etc.) show beneficial effects in providing a macroscopic view of preoperative tumor position, they are still failing to provide intraoperative real-time imaging navigation during the surgery and need oral or intravenous injection contrast agents with risk of adverse effects. In this work, we present a nano-spray assisted photothermal imaging system for in vitro cells discrimination as well as in vivo visualization of tumor position and border that guides real-time precise tumor resection during surgery (even for tiny tumor less than 3 mm). Herein, the nano-spray were prepared by RGD peptide functionalized polydopamine (PDA-RGD) nanospheres with excellent photothermal conversion efficiency (54.27%), stability and reversibility, which target ανβ3 integrin overexpressed tumor cells. Such PDA-RGD serve as nanothermometers that convert and amplify biological signal to intuitive thermal image signal, depicting the tumor margin in situ. In comparison to conventional imaging techniques, our approach through topical spraying together with portable infrared camera has the characteristics of low cost, convenient, no radiation hazard, real-time intraoperative imaging-guidance and avoiding the adverse effects risk of oral or intravenous contrast agent. This technology provides a new universal tool for potentially assisting surgeons’ decision in real-time during surgery and aiding to improved outcome.