Biologic nanosystems for fluorescence-guided surgery in oncology: A review of applicability in solid tumors for enhancing diagnostic and therapeutic modalities

Integrating biologic nanosystems (NS) with fluorescence-guided surgery (FGS) represents a significant advancement in surgical oncology, offering improved precision for tumor visualization and targeted treatments. FGS and phototherapies, including photodynamic and photothermal therapy, have demonstrated the potential to enhance intraoperative decision-making and therapeutic efficacy. This review explores the latest applications of biologically derived NS functionalized with near-infrared (NIR) fluorophores, emphasizing their role in real-time tumor delineation and multimodal treatment strategies. Key NS are analyzed in the context of their ability to enhance imaging contrast, optimize fluorophore stability, and improve selective tumor targeting. Moreover, we discuss clinically approved NIR fluorophores and their translation into NS conceived to overcome existing limitations. Particular attention is given to the theranostic applications of NS, paving the way for precision oncology. The future of biologic NS in FGS is promising, yet challenges such as cost-effectiveness, regulatory approval, and large-scale clinical implementation remain.