Michal Heger

Pancreatic ductal adenocarcinoma (PDAC) is an invasive cancer with poor survival outcomes and limited treatment options. This systematic review aimed to identify and evaluate tissue-based biomarkers with potential applications in fluorescence-guided surgery (FGS), an approach that enables real-time intraoperative tumour visualisation to improve surgical precision. A systematic review was conducted in accordance with PRISMA guidelines and registered on PROSPERO (CRD420251056295). A comprehensive literature search was conducted across MEDLINE, Embase, and Cochrane Library databases from 1980 to January 2026 and was updated in March 2026. The EU Clinical Trials Registers were also searched for biomarker-targeted clinical trials. The TASC-T (Theranostic Target Selection Criteria) scoring system was used to assess biomarker suitability. EGFR, MSLN, CEA, and integrin αvβ6 scored highest, reflecting their strong potential as theranostic targets. MUC1 and uPAR also demonstrated high positivity and accessibility for imaging and therapy. While CA19-9 is a widely used serum biomarker, its role as a tissue target appears limited because of its high expression in benign conditions. EGFR and αvβ6 are both undergoing evaluation in phase II clinical trials and have emerged as promising targets for FGS in PDAC. This review highlights the need for standardised protocols and collaborative research to expand the clinical utility of these biomarkers. The methods and scoring criteria used in this review provide a transferable framework for identifying tissue biomarkers in other cancers and disease states.

Background: The use of personal protective equipment (PPE) is essential to protect healthcare workers (HCWs) involved in COVID-19 care. In April 2020, the Ministry of Health of Indonesia issued a national PPE guideline for COVID-19, recommending specific PPE use across 15 situations based on location, personnel and activities. This study aimed to investigate the compliance with these recommendations in Indonesian hospitals, based on infection prevention and control (IPC) committee reporting, and to describe related challenges. Methods: A cross-sectional study was conducted in Indonesia from July to November 2021. Questionnaires were distributed to the hospitals’ IPC committees. Responses to PPE questions were compared with the national guideline and categorised into underuse, compliant, overuse and simultaneous underuse and overuse per situation. Additional questions addressed HCW screening and environmental disinfection. Results: A total of 355 hospitals participated, of which 80.3% were COVID-19 referral hospitals. Overall compliance with the national PPE guideline was low (median 1 of 15 situations), while overuse predominated (median 7 of 15 situations). PPE items not recommended by the national guideline, including coveralls, double masking and N95 masks (situations without aerosol-generating procedures (AGPs)), were reported. Conversely, N95 mask use in AGP situations where it is mandatory was reported at <100%. Compliance in AGP situations was significantly associated with hospital characteristics, including COVID-19 referral status and hospital class (p<0.05). Most hospitals (85.4%) performed regular screening for COVID-19 in HCWs, mostly by screening body temperature (65.4%). A hypochlorite-based product was the most commonly used disinfectant (60.8%). The most frequently reported challenge was excessive PPE use by HCWs. Conclusions: Compared with the national guideline, PPE compliance in most Indonesian hospitals was low with overuse most frequently observed. Overuse has implications for cost and environmental sustainability, whereas reduced compliance with the use of N95 masks in AGP raises safety concerns for HCWs and requires attention.

Photodynamic therapy (PDT) is conceptually and operationally a relatively straightforward treatment paradigm

Pancreatic ductal adenocarcinoma (PDAC) is the most common type of pancreatic cancer and is associated with poor prognosis. Despite years of research and improvements in chemotherapy regimens, the 5-year survival rate of PDAC remains dismal. Therapies for PDAC often face resistance owing in large part to an extensive desmoplastic stromal matrix. Modelling PDAC ex vivo to investigate novel therapeutics is challenging due to the complex tumour microenvironment and its heterogeneity in native tumours. Development of novel therapies is needed to improve PDAC survival rates, for which disease models that recapitulate the tumour biology are expected to bear utility. This review focuses on the existing preclinical models for human PDAC and discusses advancements in tissue remodelling to guide translational PDAC research. Further emphasis is placed on photodynamic therapy (PDT) due to the ability of this treatment modality to not only directly kill cancer cells by minimally invasive means, but also to perturb the tumour microenvironment and elicit a post-therapeutic anti-tumour immune response. Accordingly, more complex preclinical models that feature multiple biologically relevant PDAC components are needed to develop translatable PDT regimens in a preclinical setting.

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) mapping and radioimmunoguided surgery have shown promising results but lacked practicality to facilitate real-time intra-operative staging for PDAC. Fluorescence-guided surgery (FGS) offers high contrast and sensitivity, enabling the identification of cancerous tissue and positive LNs with improved precision following intravenous administration of a fluorescent agent. The unique properties of optical coherence tomography and ultrasound elastography lend themselves to be platforms for virtual biopsy intra-operatively. Conclusions: Accurate intra-operative staging of PDAC, localisation of metastatic LNs, and identification of extra-pancreatic disease remain clinically unmet needs under current detection methods and staging standards. Tumour-specific FGS combined with other diagnostic and therapeutic modalities could improve tumour detection and staging in patients with PDAC.