Robotic liver surgery for metastatic disease: A review of safety, feasibility, and outcomes

Abstract

BACKGROUND Colorectal cancer is the third most common malignancy globally, with the liver being the predominant site of metastatic disease. AIM To evaluate safety, feasibility, and outcomes of robotic liver resection (RLR) versus laparoscopic liver resection (LLR) and open liver resection (OLR) for colorectal metastasis (CRLM). METHODS This study followed Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Systematic searches in PubMed, EMBASE, Scopus, and Cochrane Library identified comparative and noncomparative reviews evaluating RLR versus LLR or OLR for CRLM. Two independent reviewers screened studies using predefined PICO (Population, Intervention, Comparator, Outcome) criteria, with data extraction focusing on conversion rates, operative outcomes, morbidity, mortality, and survival. Methodological quality was assessed via Assessment of Multiple Systematic Reviews 2. Pooled analyses were performed for comparative data; noncomparative studies were narratively synthesized. RESULTS Pooled evidence from two comparative systematic reviews (9792 patients) demonstrated that RLR offers distinct advantages over LLR and OLR, including significantly lower conversion rates (4.7%–6.7% vs 10.4%–12.4%, P < 0.001) and reduced intraoperative blood loss (190.8–266.8 mL vs 283.9–294.3 mL, P < 0.001) despite longer operating times (mean 304.1 vs 191.8 min). Perioperative safety and oncologic outcomes (R0 resection > 82%; 5-year overall survival: 53.1%–60.8%) were comparable across approaches. Three additional noncomparative reviews (n = 274) highlighted the technical practicability of RLR in complex cases (zero conversions in small cohorts, median 399.5 min for simultaneous resections). However, these findings were not included in pooled analyses due to the lack of comparator groups. Noncomparative data (n = 274) revealed higher upfront costs for RLR due to prolonged operating times (median 399.5 min) and the need for expensive equipment; however, no formal cost comparisons were available. CONCLUSION RLR is a safe and feasible alternative to LLR and OLR for CRLM, demonstrating superior technical performance and comparable short-term outcomes.