Robotic-Assisted One-Stage Resection of Colorectal Cancer with Liver Metastases

The liver is the most common site of colorectal cancer metastatic spread, which occurs in about 50% of patients. Although synchronous disease is considered to have a less favorable biology and poorer prognosis compared to metachronous disease, surgery is nowadays the only therapy offering a potential cure. Only 20% of these patients are eligible for surgery. Radical resection of primary colon cancer and liver metastasis may allow a 5-year survival rate ranging between 40–57%. Laparoscopic one-stage resection was demonstrated to be safe and effective, but sometimes it may be challenging. The diffusion of robotic surgery has recently expanded the application of robots to multivisceral-multiquadrant surgery. Compared to laparoscopy, robotic technology offers fine dissection and microsuture and a better vascular management, facilitating parenchymal-sparing surgery especially for posterior segments. The conversion rate to open surgery seems to be reduced. The hybrid approach (laparoscopy and robotic) may reduce overall operative time, reserving robotic technology for the most challenging steps. Randomized controlled trials are necessary to fully demonstrate the advantages of this technology, especially in terms of reduction of morbidity.