Near-infrared fluorescence imaging-guided targeted drug delivery in gastric tumors: From molecular design to clinical translation.

Intraoperative image guidance has become a central component of modern surgical oncology, with near-infrared (NIR) fluorescence imaging emerging as a powerful platform for real-time visualization and precision intervention. Owing to its favorable optical characteristics, including reduced tissue autofluorescence, improved penetration depth, and excellent safety profile, NIR fluorescence imaging has rapidly evolved from experimental validation to clinical integration in gastrointestinal surgery. This review summarizes recent advances in both nonspecific and molecularly targeted NIR fluorescence imaging strategies for gastric tumors, with a particular emphasis on their integration with targeted drug delivery and theranostic applications. Preclinical studies demonstrate that NIR fluorophores conjugated to drugs, antibodies, or tumor-specific ligands enable high-contrast visualization of primary and metastatic lesions while supporting image-guided resection and localized phototherapy in gastric cancer (GC), gastrointestinal stromal tumors (GISTs), and neuroendocrine tumors. Large-animal models further validate the translational feasibility of NIR imaging for intraoperative assessment of vascular perfusion, anastomotic integrity, and sentinel lymph node (SLN) mapping. Clinically, NIR fluorescence imaging, most commonly using indocyanine green, enhances SLN detection, identifies metastatic lymphatic pathways beyond conventional dissection fields, and enables objective evaluation of tissue perfusion, thereby reducing postoperative complications. Collectively, NIR fluorescence imaging represents a versatile platform that bridges molecular imaging, drug delivery, and surgical intervention. Its integration into gastric tumor management has the potential to improve surgical precision, optimize therapeutic delivery, and accelerate the development of personalized and minimally invasive treatment strategies.