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

Table 1 Overview of included systematic reviews

Ref.	Year	No. of studies	Patients (RLR, LLR, OLR)	Study designs	Key focus
Safiejko et al[6]	2024	8	3210 (530, 2680, N/A)	1 prospective, 6 retrospective, 1 randomized	RLR vs LLR intraoperative/postoperative
Machairas et al[7]	2021	9	29 (29, N/A, N/A)	Case series	Simultaneous robotic resections
Mkabaah et al[9]	2025	13	6582 (268, 3333, 2981)	2 RCTs, 1 prospective, 10 retrospectives	Comparative outcomes of RLR, LLR, OLR
Ho et al[12]	2013	19	217 (142, 43, 32)	10 case series, 2 comparative, 7 case reports	Early RLR adoption and complications
McGuirk et al[13]	2021	8	28 (28, N/A, N/A)	Case series	Technical feasibility of RLR

RLR: Robotic liver resection; LLR: Laparoscopic liver resection; OLR: Open liver resection; N/A: Not applicable.

Table 2 Conversion rates

Ref.	Year	RLR conversion rate	LLR conversion rate	OLR conversion rate	Statistical comparison
Safiejko et al[6]	2024	6.7% (NR)	12.4% (NR)	NR	LLR vs RLR: OR = 2.18, 95%CI: 1.46-3.24
Machairas et al[7]	2021	0% (0/29)	NR	NR	NR
Mkabaah et al[9]	2025	4.7% (10/214)	10.4% (328/3166)	NR	LLR vs RLR: OR = 27.50, 95%CI: 7.73-97.48
Ho et al[12]1	2013	4.6% (10/217)	NR	NR	NR
McGuirk et al[13]	2021	0% (0/28)	NR	NR	NR

¹Included conversions to laparotomy (9 cases) and hand-port laparoscopy (1 case). Pooled analyses include only comparative studies[6,9], non-comparative data are reported descriptively[7,13].

RLR: Robotic liver resection; LLR: Laparoscopic liver resection; OLR: Open liver resection; NR: Not reported; OR: Odds ratio; CI: Confidence interval.

Table 3 Perioperative morbidity and mortality

Ref.	30-day mortality	90-day mortality	Postoperative complications
Safiejko et al[6]
RLR	0.5% (2/372); RLR vs LLR: OR = 1.23, 95%CI: 0.32-4.83	0.0% (0/178); RLR vs LLR: OR = 1.78, 95%CI: 0.23-14.03	21.9% (106/482); RLR vs LLR: OR = 1.04, 95%CI: 0.81-1.32
LLR	0.7% (13/1931)	1.3% (10/789)	22.4% (404/1806)
Machairas et al[7]	0% (0/29)	0% (0/29)	37.9% (11/29)
Mkabaah et al[9]
RLR	0.7% (2/268); RLR vs OLR: OR = 1.24, 95%CI: 0.24-6.36	0.6% (1/179); RLR vs OLR: OR = 0.45, 95%CI: 0.07-3.03	23.6% (45/191); RLR vs OLR: OR = 0.52, 95%CI: 0.32-0.86
LLR	0.3% (5/1530); LLR vs OLR: OR = 1.01, 95%CI: 0.29-3.58	0.3% (1/292); LLR vs OLR: OR = 0.64, 95%CI: 0.08-5.24	16.6% (113/678); LLR vs OLR: OR = 0.50, 95%CI: 0.37-0.68
OLR	0.7% (6/862)	1.4% (4/296)	26.4% (262/992)
Ho et al[12]	0% (0/217)	0% (0/217)	20.3% (48/236)
McGuirk et al[13]	0% (0/28)	2.8% (1/28)	28.6% (8/28)

Complication rates varied by severity (e.g., Machairas et al[7] reported 9 minor vs 2 major complications). Pooled analyses include only comparative studies[6,9], non-comparative data are reported descriptively[7,12,13]. RLR: Robotic liver resection; LLR: Laparoscopic liver resection; OR: Odds ratio; CI: Confidence interval; OLR: Open liver resection.

Table 4 Oncological outcomes

Ref.	R0 resection rate	1-year OS	3-year OS	5-year OS	Key oncological findings
Safiejko et al[6]	NR	81.8% (RLR) vs 91.8% (LLR)	47.7% (RLR) vs 65.9% (LLR)	NR	Trend favoring LLR (NS)
Machairas et al[7]	100% (29/29)	NR	NR	75.2% (single study)	All R0 resections
Mkabaah et al[9]
RLR	82.1% (202/246)	100% (12/12)	41.7% (5/12)	NR	No significant differences between approaches
LLR	84.6% (2501/2957)	93.0% (213/229)	69.4% (159/229)	53.1% (191/360)
OLR	87.7% (2277/2597)	96.4% (321/333)	69.3% (231/333)	60.8% (477/785)
Ho et al[12]	NR	NR	NR	NR	Mixed malignancies included
McGuirk et al[13]	100% (28/28)	NR	NR	NR	Margin status reported for all cases1

¹McGuirk et al[13] reported clear margins for all 28 cases but did not use “R0” terminology explicitly. Pooled analyses include only comparative studies[6,9], non-comparative data are reported descriptively[7,12,13].

RLR: Robotic liver resection; LLR: Laparoscopic liver resection; OLR: Open liver resection; OS: Overall survival; NR: Not reported; NS: Not statistically significant.

Table 5 Operative and postoperative metrics

Ref.	Operating time (min)	Blood loss (mL)	Hospital stay (d)	Key findings
Safiejko et al[6]	247.9 (RLR) vs 272.9 (LLR)	190.8 (RLR) vs 294.3 (LLR)	5.8 (RLR) vs 5.6 (LLR)	RLR reduced blood loss vs LLR (P < 0.001)
Machairas et al[7]	399.5 (median)	274 (median)	7 (median)	Simultaneous resections
Mkabaah et al[9]
RLR	304.1	266.8	6.2	RLR reduced blood loss vs OLR (P < 0.001)
LLR	191.8	283.9	6.7
OLR	204.3	413.8	12.9
Ho et al12]	200-507 (range)	50-660 (range)	5.5-11.7 (range)	Early RLR experience
McGuirk et al[13]	420.3	275.6	8.6	Single-arm (no comparator)

Time and blood loss are means unless specified as median/range. Pooled analyses include only comparative studies[6,9], non-comparative data are reported descriptively[7,12,13]. RLR: Robotic liver resection; LLR: Laparoscopic liver resection; OLR: Open liver resection.

Table 6 Methodological quality (Assessment of Multiple Systematic Reviews 2 assessment)

Ref.	Confidence rating	Key strengths	Key limitations
Safiejko et al[6]	Moderate	Direct RLR vs LLR comparison	Retrospective dominance, no RCTs
Machairas et al[7]	Low	Focus on SRAR	Small cohort, no comparator group
Mkabaah et al[9]	High	Large sample, subgroup analyses	Heterogeneity in study designs
Ho et al[12]	Low	Early RLR adoption data	Outdated, mixed malignancies included
McGuirk et al[13]	Low	Detailed technical insights	Small sample, case series bias

RLR: Robotic liver resection; LLR: Laparoscopic liver resection; SRAR: Simultaneous robotic resections; RCT: Randomized clinical trial.