Recently, advancements in lung cancer surgery have focused on enhancing the patient's quality of life by maximizing the removal of cancerous tissue while conserving as much healthy tissue as possible. Large-scale clinical studies from the US and Japan have shown that for early-stage lung cancer lesions smaller than 2cm, a limited segmentectomy provides a 5-year survival rate comparable to that of a lobectomy, but with greater preservation of normal lung tissue. However, segmentectomy demands precise demarcation between cancerous lung segments and healthy areas, a topic that has been underexplored in research. Now, new research has revealed that lung tumors and intersegmental lines can be simultaneously explored and resected using dual-channel fluorescence agents.

In a first-of-its-kind joint research, a team from the Department of Thoracic and Cardiovascular Surgery, Korea University's Guro Hospital (Seoul, South Korea) and Harvard Medical School (Boston, MA, USA) has developed a technique for precise and safe pulmonary segmentectomy. This technique utilizes dual-channel near-infrared fluorescence imaging to delineate cancer margins, employing two types of fluorescence (cRGD-ZW800-PEG at 800 nm wavelengths and ZW700-1C at 700 nm wavelengths). This approach allows surgeons to simultaneously identify lung tumors and intersegmental lines during the operation. The effectiveness of this dual-channel fluorescence imaging technique was assessed using medium and large-sized animal models diagnosed with lung cancer.

The results showed that both lung cancer and intersegmental lines could be simultaneously visualized for up to 30 minutes during surgery by injecting a cancer-targeting fluorescence agent (cRGD-ZW800-PEG) and contrast agents to visualize blood flow distribution around the tumor (ZW700-1C and ZW800-PEG). This confirmed the high efficacy of the fluorescence agents in surgical applications. Moreover, the dual-channel fluorescence agents proved to be both physically and chemically stable. Importantly, they demonstrated excellent in vivo safety, as evidenced by over 85% of the substance being excreted through the kidneys within four hours of intravenous administration, as verified by preclinical trials. This study result was published in the SCIE-level International Journal of Surgery.

"This study will open a new paradigm in image-guided cancer surgery via injection of cancer-targeting fluorescence (cRGD-ZW800-PEG) and ZW700-1C with excellent stability in vivo. Exploring lung tumors and intersegmental lines, which has been a difficult task so far, will now become easier using dual-channel fluorescence imaging technique," said Prof. Hyun Koo Kim of the Department of Thoracic and Cardiovascular Surgery, Korea University's Guro Hospital.

"Dual-channel near-infrared fluorescence and imaging technique can be applied not only to lung cancer but to other cancers as well. By resecting only tumors, unnecessary resection of normal tissue will be minimized and patients will have improved quality of life," added Prof. Hak Soo Choi of Harvard Medical School. 

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