Fluorescence-Guided Surgery in Pediatric Oncology: Current Practice and Future Directions.

Area of Science:

• Pediatric Oncology
• Surgical Innovation
• Medical Imaging

Background:

• Pediatric tumor resections are complex due to infiltrative growth and proximity to vital structures.
• Fluorescence-guided surgery (FGS) offers real-time visualization to improve surgical precision.
• FGS application in pediatric oncology is less explored than in adults.

Purpose of the Study:

• To review current evidence on FGS in pediatric oncology.
• To highlight unique challenges in applying FGS to pediatric cancer patients.
• To propose strategies for accelerating FGS clinical translation and assessing its value.

Main Methods:

• A narrative literature review was performed.
• Databases searched included PubMed and Embase.
• Search terms focused on fluorescence, pediatrics, neoplasms, and surgery.

Main Results:

• Indocyanine green (ICG) is used for lymph node mapping and visualizing vasculature/perfusion.
• ICG's non-specific nature and lack of histopathological validation limit tumor imaging precision.
• Novel tissue-specific agents are in trials to improve sensitivity, specificity, and identify critical structures.

Conclusions:

• Advancing FGS in pediatric oncology faces significant challenges.
• Coordinated efforts in target discovery, agent design, and clinical validation are crucial.
• Successful FGS implementation could enhance surgical precision, reduce recurrence, and improve outcomes for pediatric cancer patients.