Cancer Surgery 2.0: Guidance by Real-Time Molecular Technologies

Abstract

In vivo cancer margin delineation during surgery remains a major challenge. Despite the availability of several image guidance techniques and intraoperative assessment, clear surgical margins and debulking efficiency remain scarce. For this reason, there is particular interest in developing rapid intraoperative tools with high sensitivity and specificity to help guide cancer surgery in vivo. Recently, several emerging technologies including intraoperative mass spectrometry have paved the way for molecular guidance in a clinical setting. We evaluate these techniques and assess their relevance for intraoperative surgical guidance and how they can transform the future of molecular cancer surgery, diagnostics, patient management and care. HighlightsCancer surgery is the first treatment in many solid tumors. Quality of the initial surgery has a strong influence on the patient outcome. Tumors must be excised at best, but accurate delineation of their edges and margin definition is a huge challenge.

Mass Spectrometry-Based Differentiation of Oral Tongue Squamous Cell Carcinoma and Nontumor Regions With the SpiderMass Technology

“…Several emerging technologies have paved the way for molecular guidance in the clinical setting [19]. Among them, real-time molecular profiling by mass spectrometry (MS) coupled to either surgical [20][21][22][23], laser [24][25][26], or liquid extraction devices [27] has demonstrated their potential to discriminate the tumor and nontumor cell phenotypes.…”

Therapeutic Perspectives for the Perioperative Period in Oral Squamous Cell Carcinoma (OSCC)

“…A substantial number of practical improvements were made over the past years regarding surgical care. Besides the progress of minimally-invasive surgery, robotics and ≪ augmented ≫ surgery [58], the implementation of Enhanced Recovery After Surgery (ERAS) protocols [59][60][61] represents a significant attempt to modernize surgical procedures. The ERAS protocols constitute a collection of supportive measures that aim to reduce some of the complications and negative effects of surgery, such as surgical stress.…”

Metabolic profiles of human brain parenchyma and glioma for rapid tissue diagnosis by targeted desorption electrospray ionization mass spectrometry

“…Moreover, spatial registration between a patient's brain and the preoperative MR images may be compromised as brain shift is common during craniotomies [4]. Consequently, intraoperative tissue diagnosis increasingly relies on molecular features assessed from tumor biopsies [5] to locate the tumor boundary with a higher sensitivity and to provide additional pathological information, like tumor grade and genetic mutation [6]. Ultimately, this should allow surgeons to maximize tumor resection and personalize adjunctive therapies.…”

“…Raman spectroscopy can be conducted either in vivo, with a handheld Raman probe placed directly on the tissue surface for data acquisition [3], or ex vivo to analyze brain biopsies with little sample preparation, automatic data acquisition and analysis, and near-immediate feedback [11]. Additionally, ambient ionization mass spectrometry (MS) has been identified as a potential method for intraoperative tissue diagnosis [5,12], given its capability of sensitive and rapid metabolite characterization. MS-based techniques use various approaches of rapid and simple tissue sampling.…”