Laparoscopic versus robotic surgery in the setting of combined resection of colorectal cancer and liver metastases: an experience from the I Go MILS registry

Approximately 25% of patients with colorectal cancer (CRC) are diagnosed with distant metastases, with the liver being the most common site. A simultaneous approach to resections in these patients may lead to higher complication rates. Recent research suggests that minimally invasive surgical (MIS) techniques can help reduce this additional morbidity. This study examines a multicenter Italian experience, comparing perioperative outcomes of robotic (RS) and laparoscopic surgery (LS) in this setting. Patients from the prospective multicentre registry of the Italian Group of Minimally Invasive Liver Surgery (I Go MILS) who underwent MIS simultaneous resection for CRC with colorectal liver metastasis between 2015 and 2025 were included. Perioperative outcomes were compared between RS and LS using nearest neighbor matching with 2:1 ratio and caliper of 0.2 to mitigate the selection bias. A total of 505 patients were analyzed, including 415 undergoing LS and 90 undergoing RS. After matching, demographic characteristics were similar. Operative time, conversion rate (11.71% for LS vs 6.67% for RS, p = 0.224) and length of stay were comparable between the two groups. Robotic surgery enabled more challenging resections compared to laparoscopy and after matching for complexity was associated with lower major complications (21.62% vs 8.89%, p = 0.014). The robotic approach has demonstrated superior feasibility for technically challenging resections while maintaining similar length of stay, rate of conversion and postoperative complications, after matching for complexity RS was associated with a significantly lower rate of major complications. Robotic surgery can be an alternative to open surgery in complex cases in order to maximise the benefits of minimally invasive surgery and to have better short term postoperative outcomes.