Robotic synchronous resection of rectal cancer and liver metastases: Current evidence and review

Synchronous rectal and liver resection for metastatic colorectal cancer offers a unique opportunity to treat patients with a single stage procedure. Traditional open resections were out of favour due to a high morbidity profile. Robotic resections offer these benefits with an apparent reduction in morbidity and similar oncological outcomes. The present review aims to ascertain the feasibility, safety and available outcomes for patients undergoing synchronous resections for rectal cancer with liver metastases. A systematic review was performed along the PRISMA guidelines with “robotic”, “rectal cancer”, “colorectal”, “synchronous resection” and “liver metastases” as the key words on the MEDLINE, EMBASE and Cochrane databases. Appropriate studies published between May 1 st 2015 and May 1 st 2023 were chosen and the data were collated from individual patients and analysed. A total of 12 studies were included, comprising of 48 patients. Eight included studies were case series and the rest were case reports and brief communications. There were no appropriate prospective studies for analysis. The median age was 61 years (IQR- 55–73 years) and 80% of patients whose gender data were available (n-15) were men. The median operative duration was 376 ​min (IQR- 312–424 min) with estimated blood loss of 175 ​ml (125–225 ​ml). The median length of hospital stay was 5.5 days (IQR- 3.5-7). There was no mortality and all the resections were R0. Synchronous robotic resections for rectal cancer with liver metastases is feasible on the current review and has good short term and peri-operative outcomes. However, there is paucity of high quality published data in this subset of patients. Further prospective studies are needed to confirm the findings of the current review and to resolve the lack of high quality evidence.