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Published on: December 15, 2023
A systematic methodology review of fluorescence-guided cancer surgery to inform the development of a core master
1Centre for Surgical Research, Population Health Sciences, University of Bristol, 39 Whatley Road, Clifton, Bristol, BS8 2PS, UK. a.e.vallance@doctors.org.uk.
Background:
Fluorescence-guided precision cancer surgery may improve survival and minimize patient morbidity. Efficient development of promising interventions is however hindered by a lack of common methodology. This methodology review aimed to synthesize descriptions of technique, governance processes, surgical learning and outcome reporting in studies of fluorescence-guided cancer surgery to provide guidance for the harmonized design of future studies.
Methods:
A systematic search of MEDLINE, EMBASE and CENTRAL databases from 2016-2020 identified studies of all designs describing the use of fluorescence in cancer surgery. Dual screening and data extraction was conducted by two independent teams.
Results:
Of 13,108 screened articles, 426 full text articles were included. The number of publications per year increased from 66 in 2016 to 115 in 2020. Indocyanine green was the most commonly used fluorescence agent (391, 91.8%). The most common reported purpose of fluorescence guided surgery was for lymph node mapping (195, 5%) and non-specific tumour visualization (94, 2%). Reporting about surgical learning and governance processes incomplete. A total of 2,577 verbatim outcomes were identified, with the commonly reported outcome lymph node detection (796, 30%). Measures of recurrence (32, 1.2%), change in operative plan (23, 0.9%), health economics (2, 0.1%), learning curve (2, 0.1%) and quality of life (2, 0.1%) were rarely reported.
Conclusion:
There was evidence of methodological heterogeneity that may hinder efficient evaluation of fluorescence surgery. Harmonization of the design of future studies may streamline innovation.
Insights
Methodological inconsistencies in fluorescence-guided cancer surgery studies hinder progress. Harmonizing study designs is crucial for efficient evaluation and innovation in this precision surgery technique.
Area of Science:
- Oncology
- Surgical Innovation
- Medical Methodology
Background:
- Fluorescence-guided surgery offers potential for improved cancer patient survival and reduced morbidity.
- Current development of fluorescence-guided interventions is slowed by a lack of standardized methodologies.
- This review addresses technique, governance, learning, and outcome reporting in fluorescence-guided cancer surgery.
Purpose of the Study:
- To synthesize descriptions of methodology in fluorescence-guided cancer surgery studies.
- To provide guidance for harmonized study design in future research.
- To identify gaps in reporting for surgical learning and governance processes.
Main Methods:
- Systematic literature search of MEDLINE, EMBASE, and CENTRAL databases (2016-2020).
- Inclusion of studies describing any use of fluorescence in cancer surgery.
- Dual screening and data extraction by two independent teams.
Main Results:
- 426 full-text articles were included from 13,108 screened records.
- Indocyanine green was the predominant fluorescence agent (91.8%).
- Lymph node mapping (5%) and tumor visualization (2%) were common applications, but reporting on surgical learning, governance, recurrence, health economics, and quality of life was limited.
Conclusions:
- Methodological heterogeneity in current studies may impede the efficient evaluation of fluorescence-guided surgery.
- Standardizing the design of future studies is essential to streamline innovation and improve clinical adoption.
