Published online Nov 27, 2025. doi: 10.4240/wjgs.v17.i11.109989
Revised: July 20, 2025
Accepted: October 10, 2025
Published online: November 27, 2025
Processing time: 182 Days and 7.3 Hours
Colorectal cancer is the third most common malignancy globally, with the liver being the predominant site of metastatic disease.
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).
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.
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.
RLR is a safe and feasible alternative to LLR and OLR for CRLM, demonstrating superior technical performance and comparable short-term outcomes.
Core Tip: Robotic liver resection (RLR) for colorectal metastases offers clear advantages over laparoscopic and open approaches. This review, integrating robust comparative and noncomparative evidence, reveals significantly lower conversion rates and reduced blood loss of RLR, while maintaining comparable short-term safety and oncological outcomes. It highlights the technical feasibility of RLR in complex cases. While longer operating times and limited long-term data for major resection warrant further research, this comprehensive analysis positions RLR as a safe, feasible, and technically superior alternative, advancing precision in surgical oncology.