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Review
. 2023 Jul 20;15(14):3694.
doi: 10.3390/cancers15143694.

Intraoperative Imaging in Hepatopancreatobiliary Surgery

Tereza Husarova  1   2 , William M MacCuaig  1 , Isabel S Dennahy  1 , Emma J Sanderson  1 , Barish H Edil  1 , Ajay Jain  1 , Morgan M Bonds  1 , Molly W McNally  1 , Katerina Menclova  2 , Jiri Pudil  2 , Pavel Zaruba  2 , Radek Pohnan  2 , Christina E Henson  3 , William E Grizzle  4 , Lacey R McNally  1
Affiliations
Review

Intraoperative Imaging in Hepatopancreatobiliary Surgery

Tereza Husarova et al. Cancers (Basel). .

Abstract

Hepatopancreatobiliary surgery belongs to one of the most complex fields of general surgery. An intricate and vital anatomy is accompanied by difficult distinctions of tumors from fibrosis and inflammation; the identification of precise tumor margins; or small, even disappearing, lesions on currently available imaging. The routine implementation of ultrasound use shifted the possibilities in the operating room, yet more precision is necessary to achieve negative resection margins. Modalities utilizing fluorescent-compatible dyes have proven their role in hepatopancreatobiliary surgery, although this is not yet a routine practice, as there are many limitations. Modalities, such as photoacoustic imaging or 3D holograms, are emerging but are mostly limited to preclinical settings. There is a need to identify and develop an ideal contrast agent capable of differentiating between malignant and benign tissue and to report on the prognostic benefits of implemented intraoperative imaging in order to navigate clinical translation. This review focuses on existing and developing imaging modalities for intraoperative use, tailored to the needs of hepatopancreatobiliary cancers. We will also cover the application of these imaging techniques to theranostics to achieve combined diagnostic and therapeutic potential.

Keywords: hepatopancreatobiliary surgery; image-guided surgery; intraoperative imaging; targeted imaging.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 4
Figure 4
Visualization of a fluorescent anti-carcinoembryonic antigen–antibody in peritoneal (A) and liver (B) metastases of a pancreatic tumor, 48h post-intravenous injection [57]. Figure from Ann. Surg. Oncol. 2018, 25, 3350–3357 [57].
Figure 5
Figure 5
Visualization of optoacoustic nanoparticle accumulation in a pancreatic tumor of a xenograft murine model. Each image represents a different tomographic slide in the animal. Figure adapted from ACS Appl. Mater. Interfaces 2021, 13, 49614–49630 [71].
Figure 6
Figure 6
Visualization of multiple optoacoustic contrast agents using single wavelength 900nm (A) and with multiple wavelengths separately (ICG (B), Syndecan1 probe (C)) and simultaneously (D) following spectral unmixing using an in vivo murine model. Figure from J. Surg. Res. 2015, 193, 246–254 [75].
Figure 1
Figure 1
Satellite lesion (black arrow) of colorectal carcinoma liver metastasis with borderline visibility on ultrasound or CT. Original figure.
Figure 2
Figure 2
Commonly used ultrasound methods (red arrow indicates mass): (A) endoscopic ultrasound of pancreatic lesion, (B) preoperative transabdominal ultrasound of HCC liver lesion, (C) intraoperative ultrasound of HCC liver lesion close to the vasculature (identical lesion to image (B)). Original figure.
Figure 3
Figure 3
Ultrasound-guided radiofrequency ablation in the liver (arrow points toward the needle). Original figure.
See this image and copyright information in PMC

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