Research group/lab | P.I. Dr. S. (Stijn) Keereweer, P.I. Dr. D.E. (Denise) Hilling

Fluorescence-Guided Surgery Group

Fluorescence-guided surgery is an intraoperative optical imaging method that provides surgeons with real-time guidance for the identification and delineation of tumours or vital structures. This novel approach is being tested by different surgical disciplines within the Erasmus MC.

P.I. Dr. S. (Stijn) Keereweer

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Fluorescence-Guided Surgery Group

About our research group/lab

Our research

Focusgroup Fluorescence-Guided Surgery

Our focusgroup on fluorescence-guided surgery joins together all researchers that are involved in this field, extending over 8 different surgical disciplines. Through close collaboration, we empower our group to facilitate a more efficient and productive research line. By forming trans-disciplinary partnerships, we have performed multiple clinical trials, we have improved coordination of the use of imaging facilities, and we have coordinated and combined efforts for investments in new imaging devices and of research funding. We facilitate communication with secondary partners such as the pharmacy, medical ethical committee (METC), and the technology transfer office (TTO).

As correlation with pathology is critical in evaluation of intraoperative fluorescence imaging technology, we have invested in a robust and clinically standardized pipeline of pathological analysis that is equal to no other in the world. Through a shared post-doc appointment in Imaging Physics(TU-Delft), we have been on top of the latest technological innovations, resulting into new collaborations and projects. As co-founders and board members of the Dutch Fluorescence-guided Surgery group (www.dfgs-group.org), we organize national and international partnerships and conferences. This initiative flourishes through our close partnership with pioneering researchers at the Leiden University Medical Centre.

Over the past years, our initiative has thereby evolved into one of the leading centers within the rapidly expanding field of intraoperative optical imaging. As the largest oncological center in The Netherlands for many cancer types (e.g. Head and Neck cancer), we are therefore ideally positioned to perform large-scale clinical trials in fluorescence-guided surgery.

Our projects

Our current projects

Intraoperative tumor-specific fluorescence imaging of oral cancer (“Guided by Light” trial); laryngeal/hypopharyngeal cancer (“STELLAR” trial)
Intraoperative ex-vivo tumor-specific fluorescence imaging of cancer (“RESIDUAL trial”)
Fluorescence imaging of recurrent and locally advanced rectal cancer using SGM-101 (“SGM-LARRC trial”)
Complementary use of fluorescence-guided surgery and Raman spectroscopy
Vascular perfusion of anastomosis and reconstructive surgery

IMPACT trial: perfusion imaging in trauma surgery
RULER project: perfusion imaging in vascular surgery)
FAFI trial: perfusion imaging of DIEP flaps

Ureter visualization using fluorescence imaging (“TRIPHASE trial”)
Sentinel lymph node imaging using fluorescence imaging during oncological surgery (melanoma and breast cancer)
ICG Fluorescence Lifetime and Reflectance Spectroscopy for the Detection of Occult Lymph Node Metastasis

Key Publications

2024
Indocyanine green near-infrared fluorescence bowel perfusion assessment to prevent anastomotic leakage in minimally invasive colorectal surgery (AVOID): a multicentre, randomised, controlled, phase 3 trial
Robin A Faber, Ruben P J Meijer, Daphne H M Droogh, Jasmijn J Jongbloed, Okker D Bijlstra, Fran Boersma, Jeffrey P B M Braak, Elma Meershoek-Klein Kranenbarg, Hein Putter, Fabian A Holman, J Sven D Mieog, Peter A Neijenhuis, Esther van Staveren, Johanne G Bloemen, Jacobus W A Burger, Tjeerd S Aukema, Mark A M Brouwers, Andreas W K S Marinelli, Marinke Westerterp, Pascal G Doornebosch, Annelies van der Weijde, Koop Bosscha, Henricus J M Handgraaf, Esther C J Consten, Daan J Sikkenk, Jacobus Burggraaf, Stijn Keereweer, Joost R van der Vorst, Merlijn Hutteman, Koen C M J Peeters, Alexander L Vahrmeijer, Denise E Hilling
39151436
https://pubmed.ncbi.nlm.nih.gov/39151436/

2024
Molecular-Targeted Fluorescence Lymph Node Imaging Could Play a Clinical Role in the Surgical Setting: A Systematic Review
Bo E Zweedijk, Sebastiaan W R Dalmeijer, Labrinus van Manen, Hidde A Galema, Lorraine J Lauwerends, Hamed Abbasi, Bernd Kremer, Cornelis Verhoef, Dominic J Robinson, Sjors
A Koppes, Alexander L Vahrmeijer, Joost R van der Vorst, Denise E Hilling, Stijn Keereweer40282528
https://pubmed.ncbi.nlm.nih.gov/40282528/

2024:
Tumour Marker Expression in Head and Neck Malignancies to Identify Potential Targets for Intraoperative Molecular Near-Infrared Imaging.
Lauwerends LJ, Zweedijk BE, Galema HA, Neijenhuis LKA, Dekker-Ensink NG, Baatenburg de Jong RJ, Verhoef C, Bhairosingh SS, Kuppen PJK, Vahrmeijer AL, van Ginhoven TM, Koljenović S, Koppes SA, Hilling DE, Keereweer S.
39251469
https://pubmed.ncbi.nlm.nih.gov/39251469/

2024:
Transcutaneous sentinel lymph node detection in skin melanoma with near-infrared fluorescence imaging using indocyanine green.
Zweedijk BE, Schurink AW, van Dalen T, van Ginhoven TM, Verhoef C, Kremer B, Hilling DE, Keereweer S, Grünhagen DJ.
39088239
https://pubmed.ncbi.nlm.nih.gov/39088239/

2023:
Intraoperative molecular imaging of colorectal lung metastases with SGM-101: a feasibility study.
Meijer RPJ, Galema HA, Faber RA, Bijlstra OD, Maat APWM, Cailler F, Braun J, Keereweer S, Hilling DE, Burggraaf J, Vahrmeijer AL, Hutteman M; SGM-CLM study group.Eur J Nucl Med Mol Imaging. 2023 Aug 8. doi: 10.1007/s00259-023-06365-3. Online ahead of print.PMID: 37552367
https://pubmed.ncbi.nlm.nih.gov/37552367/

2023:
Quantification of indocyanine green near-infrared fluorescence bowel perfusion assessment in colorectal surgery.
Faber RA, Tange FP, Galema HA, Zwaan TC, Holman FA, Peeters KCMJ, Tanis PJ, Verhoef C, Burggraaf J, Mieog JSD, Hutteman M, Keereweer S, Vahrmeijer AL, van der Vorst JR, Hilling DE.
Surg Endosc. 2023 Sep;37(9):6824-6833. doi: 10.1007/s00464-023-10140-8. Epub 2023 Jun 7.
https://pubmed.ncbi.nlm.nih.gov/37286750/

2023:
A quantitative assessment of perfusion of the gastric conduit after oesophagectomy using near-infrared fluorescence with indocyanine green.
Galema HA, Faber RA, Tange FP, Hilling DE, van der Vorst JR; Upper-GI ICG quantification study group.
Eur J Surg Oncol. 2023 May;49(5):990-995. doi: 10.1016/j.ejso.2023.02.017. Epub 2023 Mar 2.
https://pubmed.ncbi.nlm.nih.gov/36914531/

2023:
Fluorescence-guided surgery using methylene blue to improve identification of metastatic small intestinal neuroendocrine tumours.
Galema HA, van Ginhoven TM, Franssen GJH, Hofland J, Bouman CGOT, Verhoef C, Vahrmeijer AL, Hutteman M, Hilling DE, Keereweer S.
Br J Surg. 2023 Apr 12;110(5):541-544. doi: 10.1093/bjs/znad043.
https://pubmed.ncbi.nlm.nih.gov/36861217/

2023:
Development of a near-infrared Raman spectroscopy setup compatible with fluorescence-guided surgery.
Abbasi H, Lauwerends LJ, Bakker Schut TC, Santos IP, Caspers PJ, Hardillo JAU, Koljenović S, Vahrmeijer AL, Baatenburg de Jong RJ, Keereweer S, Puppels GJ.
Analyst. 2023 Jun 12;148(12):2676-2682. doi: 10.1039/d3an00077j.
https://pubmed.ncbi.nlm.nih.gov/37077171/

2022:
The complementary value of intraoperative fluorescence imaging and Raman spectroscopy for cancer surgery: combining the incompatibles.
Lauwerends LJ, Abbasi H, Bakker Schut TC, Van Driel PBAA, Hardillo JAU, Santos IP, Barroso EM, Koljenović S, Vahrmeijer AL, Baatenburg de Jong RJ, Puppels GJ, Keereweer S.
Eur J Nucl Med Mol Imaging. 2022 Jun;49(7):2364-2376. doi: 10.1007/s00259-022-05705-z. Epub 2022 Feb 1.
https://pubmed.ncbi.nlm.nih.gov/35102436/

2022:
Fluorescence-guided surgery in colorectal cancer; A review on clinical results and future perspectives.
Galema HA, Meijer RPJ, Lauwerends LJ, Verhoef C, Burggraaf J, Vahrmeijer AL, Hutteman M, Keereweer S, Hilling DE.
Eur J Surg Oncol. 2022 Apr;48(4):810-821. doi: 10.1016/j.ejso.2021.10.005. Epub 2021 Oct 9.
https://pubmed.ncbi.nlm.nih.gov/34657780/

2021:
Real-time fluorescence imaging in intraoperative decision making for cancer surgery
Lorraine J Lauwerends, Pieter B A A van Driel, Robert J Baatenburg de Jong,
José A U Hardillo, Senada Koljenovic, Gerwin Puppels, Laura Mezzanotte, Clemens W G M Löwik, Eben L Rosenthal, Alexander L Vahrmeijer, Stijn Keereweer.
The Lancet Oncology Published online March 22, 2021 doi.org/10.1016/S1470-2045(20)30600-8.
https://pubmed.ncbi.nlm.nih.gov/33765422/

2021:
Fluorescence-guided surgery in colorectal cancer; A review on clinical results and future perspectives.
Galema HA, Meijer RPJ, Lauwerends LJ, Verhoef C, Burggraaf J, Vahrmeijer AL, Hutteman M, Keereweer S & Hilling DE.
Eur J Surg Oncol. 2021 Oct 9:S0748-7983(21)00755-1. doi: 10.1016/j.ejso.2021.10.005.
https://pubmed.ncbi.nlm.nih.gov/34657780/

2021:
Current Intraoperative Imaging Techniques to Improve Surgical Resection of Laryngeal Cancer: A Systematic Review.
Lauwerends LJ, Galema HA, Hardillo JAU, Sewnaik A, Monserez D, van Driel PBAA, Verhoef C,
Baatenburg de Jong RJ, Hilling DE, Keereweer S.
Cancers (Basel). 2021 Apr 15;13(8):1895. doi: 10.3390/cancers13081895.
https://pubmed.ncbi.nlm.nih.gov/33920824/

Collaborations

Department of Otorhinolaryngology Head and Neck Surgery

Department of Surgical Oncology and Gastrointestinal Surgery

Department of Radiology & Nuclear Medicine

Department of Plastic Surgery

Department of Molecular Genetics

Department of Pathology

Department of Gynecology

Department of Urology

Department of Surgical Oncology, Leiden University Medical Center

Funding & Grants

2025: Erasmus MC-TKI-LSH Match Call II for PPP Allowance
PIs: Hamed Abbasi, Dominic Robinson, Stijn Keereweer
Consortium partner: Single Quantum B.V.
Title: “ICG Fluorescence Lifetime and Reflectance Spectroscopy for the Detection of Occult Lymph Node Metastasis”
Funding: €606.770,00

2024: Michel Keijzer Fonds - Patiëntenvereniging Hoofd-Hals
PI: Stijn Keereweer, Denise Hilling
Title: “Ex-vivo topicale fluorescente beeldvorming: een unieke nieuwe techniek om tijdens de operatie te controleren of strottenhoofdkanker volledig is verwijderd.”
Funding: €100.000,00

2023: Team Westland
PI: Stijn Keereweer, Denise Hilling
Title: “Gebruik van fluorescent licht om strottenhoofdkanker nauwkeuriger te kunnen verwijderen.”
Funding: €161.000,00

2020: Maurits en Anna de Kock Stichting
PI: Stijn Keereweer, Tessa van Ginhoven
Title: “Improving surgical removal of oral cancer using fluorescence-guided surgery.”Funding: €40.000,00

2019: Daniel den Hoed Award / Erasmus MC Fund
PI: Stijn Keereweer (Personal Grant)
Post-doc: Hamed Abbasi
Title: “Improving surgical removal of oral cancer using a unique, innovative combination of fluorescence-guided surgery and Raman spectroscopy”
Funding: €250.000,00

2019: Young Investigator Grant from the Dutch Cancer Society
PI: Stijn Keereweer (Personal Grant)
PhD student: L. Lauwerends
Title: “Guided by light: Optimizing surgical excision of oral cancer using real-time fluorescence imaging”
Funding: €497.935,00

2019: Applied Efficiency Grant / Erasmus MC
PI: Dirk Grunhagen, Stijn Keereweer
PhD Student: E. Mulder
Title: “MOTOR pilot study - Ex Vivo Application of Multispectral Optoacoustic Tomography & Reflectance Spectroscopy in Lymph Nodes and Pigmented Tissue”
Funding: €86.108,00

2019: Maurits en Anna de Kock Stichting
PI: Stijn Keereweer, Elisa Barroso
Title: “Improving surgical removal of oral cancer using an innovative combination of fluorescence-guided surgery and Raman spectroscopy.”
Funding: €36.370,00

2018: Dutch Cancer Society Consortium Grant
PI: Denise Hilling, Kees Verhoef, Alexander Vahrmeijer (LUMC), Harm Rutten (CZE)
PhD student: Job van Kooten, Hidde Galema, Jan van Rees
Title: Tumour-specific near-infrared fluorescence imaging in locally advanced and recurrent rectal cancer
Funding: €1.071.553,00