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Page 2 of 5 Sammarco et al. Mini-invasive Surg 2019;3:31 I http://dx.doi.org/10.20517/2574-1225.2019.33
[1]
is still controversial with different opinion on the subject . In patients with resectable disease, surgical
resection can be considered the only potentially curative treatment even if operative sequence on the
[2]
management of CRC and liver metastasis (CLM) still remain unclear . Considering that 20%-40% of all
patients with CRC presents at the time of diagnosis, two main strategies are available for patients with
synchronous metastasis, treating primarily the liver (liver first) or the colon (colon first). In some cases,
especially in case of oligometastatic lesion of the liver, considering the spread of parenchymal sparing
[3]
surgery , it has been demonstrated that synchronous treatment could be considered a safe option, with
[2]
acceptable morbidity and mortality . Initially, the introduction of minimally invasive surgery (MIS)
has probably limited synchronous metastasis treatment due to the technical difficulties of two different
kind of resection. Despite this, nowadays, various studies have demonstrated the feasibility of MIS for
[4]
synchronous liver and CRC . With the introduction of robotic surgery, it represent a valid alternative lo
laparoscopic surgery achieve optimal surgical and oncological outcomes. Considering robotic surgery, The
well-known advantages of for laparoscopic surgery are preserved (shorter length of stay, reduced blood
[5-8]
loss and postoperative morbidity) adding the advantages of robotic (magnified 3d dimensional vision,
a very good access allowed for posterosuperior segment’s lesions or in contact with main liver vessels, less
development of adhesions, tremor suppression, flexibility of the instruments).

The aim of this study is to present a systematic review of the literature to present the results of robotic
surgery for colorectal liver metastasis in terms of short and long terms results.

METHODS
The present study was designed following the PRISMA guidelines.

A systematic literature search was performed by two authors (Sammarco A, Memeo R) using PubMed,
EMBASE, Scopus and Cochrane Library Central restricting to papers in English language, finding studies
and articles published from 1998 to 2018, focusing the study on the synchronized treatment of the liver
metastasis and the CRC. All studies including patients who underwent robotic liver resection for colorectal
liver metastasis were considered as eligible for the study, especially studies who considered synchronous
pure robotic resection of CLM and CRC.

The following MESH search in heading were used: “robotic”, “robot-assisted”, “minimally invasive”, “liver
metastasis”, “colorectal cancer”, “stage 4”, “combined resection”, “simultaneous resection”, and “synchronous
resection”.

All series containing other liver resection for different pathologies were excluded.

RESULTS
We retrospectively reviewed collected data included OT, perioperative blood loss, disease free, overall
survival. We identified 16 relevant articles, to analyse the role of the MIS in patients with colorectal liver
metastases (CRLM) and previous or synchronous surgery, focusing our attention on robotic assisted
surgery (RAS). Just three of this 16 concerned CRLM only.

CRLM and RAS
Actually in literature, due to the reduced number of series describing RAS liver resection, most series
comprehend different kind of pathology, mostly hepatocellular carcinoma and CRLM. Only 3 series
described detailed results with only CRLM [Table 1] [9-11] : 2 were retrospective and 1 prospective The
number of patients ranged from 6 to 59. No data were available on number of resected lesions. Only one
series presented major resection: 1 left hepatectomy, 3 right hepatectomy in a total of 82 resected patients