The authors enrolled seven patients with colorectal peritoneal metastases scheduled for cytoreductive surgery and HIPEC. Two days before surgery, the patients were given 4.5 mg i.v. of the near-infrared fluorescent tracer bevacizumab-IRDye800CW. The primary endpoints were safety and feasibility, i.e. “safe” if no allergic or anaphylactic reactions or serious adverse events occurred that were linked to bevacizumab-IRDye800CW, and “feasible” if bevacizumab-IRDye800CW enabled detection of fluorescence signals during surgery.
– The safety results:
o Two patients developed serious adverse events, but both were attributed to the surgical cytoreductive surgery and HIPEC procedure.
o By contrast, there were no serious adverse events related to bevacizumab-IRDye800CW.
– The feasibility results:
o Fluorescence was seen intraoperatively in all patients.
o In two patients, the fluorescence-guided surgery managed to spot additional tumour tissue initially missed by the surgeon.
o 29 areas were ‘non-fluorescent’, all of these were found to contain only benign tissue
o 51 areas were fluorescent, 27 of which contained tumor tissue.
Using molecular fluorescence-guided surgery with the near-infrared fluorescent tracer bevacizumab-IRDye800CW is safe and feasible, conclude the authors, and might improve patient selection as well as optimizing cytoreductive surgery. As this was a small, single-center study, the authors now call for a multicenter phase 2 trial to confirm the diagnostic accuracy and to investigate the effect of this technique on clinical decision making.