Intra-Operative Tumour Detection and Staging in Pancreatic Cancer Surgery - An Integrative Review of Current Standards and Future Directions

Sep 21, 2026

Surgical resection for pancreatic ductal adenocarcinoma requires accurate primary tumour removal and lymphadenectomy, yet high early recurrence indicates inadequate staging under current standards. An integrative review of studies indexed in PubMed and Embase (Jan 2000–Jun 2023) summarizes intra-operative staging and guided surgery technologies. Lymph node mapping and radioimmunoguided surgery show promise but lack real-time practicality. Fluorescence-guided surgery and optical coherence tomography or ultrasound elastography-based approaches may improve tumour and metastatic lymph node detection, addressing unmet clinical needs.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages23

Reading Time58 min

AccessFree to download

Introduction

Methods

Results

Conclusions

Review Intra-Operative Tumour Detection and Staging in Pancreatic Cancer Surgery: An Integrative Review of Current Standards and Future Directions Ahmed Kotb 1, Zaynab Hafeji 1, Fadel Jesry 1, Nicole Lintern 1, Samir Pathak 2, Andrew M. Smith 2, Kishan R. D. Lutchman 3,4, Daniel M. de Bruin 4, Rob Hurks 5, Michal Heger 6, * and Yazan S. Khaled 1,2, * Citation: Kotb, A.; Hafeji, Z.; Jesry, F.; Lintern, N.; Pathak, S.; Smith, A.M.; Lutchman, K.R.D.; de Bruin, D.M.; Hurks, R.; Heger, M.; et al. Intra-Operative Tumour Detection and Staging in Pancreatic Cancer Surgery: An Integrative Review of Current Standards and Future Directions. Cancers 2024, 16, 3803 . [https://doi.org/10.3390/](https://doi.org/10.3390/)[ ](https://doi.org/10.3390/)cancers16223803 Academic Editor: Masaru Miyazaki Received: 9 June 2024 Revised: 15 October 2024 Accepted: 6 November 2024 Published: 12 November 2024 Copyright: © 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ([https://](https://)[ ](https://)[creativecommons.org/licenses/by/](creativecommons.org/licenses/by/)[ ](creativecommons.org/licenses/by/)[4.0/](4.0/)) . 1 Leeds Institute of Medical Research, University of Leeds, Leeds LS2 9JT, UK 2 The Pancreato-Biliary Unit, St James’s University Teaching Hospital, Leeds LS9 7TF, UK 3 Department of Surgery, Amsterdam UMC, Location AMC, 1105 AZ Amsterdam, The Netherlands 4 Department of Biomedical Engineering and Physics, Amsterdam UMC, Location AMC, 1105 AZ Amsterdam, The Netherlands 5 Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands 6 Jiaxing Key Laboratory for Photonanomedicine and Experimental Therapeutics, Department of Pharmaceutics, College of Medicine, Jiaxing University, Jiaxing 314001, China * [Correspondence: michal.heger@photonanomedicine.com](Correspondence: michal.heger@photonanomedicine.com) (M.H.); [y.khaled@leeds.ac.uk](y.khaled@leeds.ac.uk) (Y.S.K.); Tel.: +86-15356737738 (M.H.); Fax: +44-1132448182 (M.H.); Tel: +113-2065281 (Y.S.K.) Simple Summary: Pancreatic cancer can be cured by surgical resection to clear margins, but this is difficult to achieve. The current methods to detect cancer spread during surgery are not very effective and many patients experience cancer returning soon after surgery. This integrative review analyses new technologies that could aid surgeons in detecting cancer more accurately during surgery. The aim is to identify methods that allow surgeons to distinguish cancerous tissues and subclinical deposits more precisely and reduce the risk of cancer recurrence. Fluorescence-guided surgery, where a light-emitting dye illuminates cancer cells, and other cancer localisation techniques are emerging as promising tools to aid oncological clearance during surgery. Accurate identification of cancer spread during surgery remains a clinical need and could change how surgeries for pancreatic cancer are conducted to prevent post-resection recurrence and improve survival. Abstract: Background: Surgical resection for pancreatic ductal adenocarcinoma (PDAC) entails the excision of the primary tumour and regional lymphadenectomy. This traditional strategy is challenged by the high rate of early recurrence, suggesting inadequate disease staging. Novel methods of intra-operative staging are needed to allow surgical resection to be tailored to the disease’s biology. Methods: A search of published articles on the PubMed and Embase databases was performed using the terms ‘pancreas’OR ‘pancreatic’AND‘intra-operative staging/detection’ OR ‘guided surgery’. Articles published between January 2000 and June 2023 were included. Technologies that offered intra-operative staging and tailored treatment were curated and summarised in the following integrative review. Results: lymph node (LN) mappin

FAQs

Why is intra-operative staging important in pancreatic ductal adenocarcinoma surgery?

Current surgical strategies face high early recurrence, suggesting inadequate staging. Better intra-operative staging helps tailor resection to tumour biology and reduces recurrence risk.

What search scope and inclusion period were used in the review?

The review searched PubMed and Embase using defined terms and included articles published from January 2000 to June 2023.

Which technologies showed promising but limited practicality for real-time staging?

Lymph node mapping and radioimmunoguided surgery demonstrated promising results but lacked practicality for real-time intra-operative staging in PDAC.

Sep 21, 2026

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