Safety and Feasibility of Robotic Simultaneous Resection of Synchronous Colorectal Cancer and Liver Metastases: A Systematic Review and Meta-Analysis

Aim: To ascertain the safety and feasibility of robotic simultaneous resection of synchronous colorectal cancer and liver metastases.Methods: A PRISMA-compliant systematic review with proportion meta-analysis was conducted.All retrospective or prospective observational studies including patients aged ≥ 18 with synchronous colorectal cancer and liver metastases undergoing robotic simultaneous resection were eligible.The outcomes included conversion to open, operative time, intraoperative blood loss, Clavien-Dindo ≥ III complications, 30-day mortality, anastomotic leak, R0 resection, and length of hospital stay.Results: Seven eligible studies including 165 patients were identified.The mean age was 62.8 years (95% CI: 60.5-65.2),mean body mass index was 26.5 (95% CI: 24.6-28.4),and 52.0%(95% CI: 37.9-66.1)were male.The mean operative time was 406.5 min (95% CI: 358.2-454.7)and mean intraoperative blood loss was 150.0 mL (95% CI: 124.5-175.6).Conversion to open occurred in 3.9% (95% CI: 1.0-6.8),Clavien-Dindo ≥ III complications in 9.3% (95% CI: 4.7-13.8),30day mortality in 0.9% (95% CI: 0.0-2.4), and anastomotic leak in 4.3% (95% CI: 0.9-7.6).R0 resection was achieved in 99.0% (95% CI: 97.5-100), and the mean length of hospital stay was 6.7 days (95% CI: 5.5-7.9).Conclusions: Single-arm meta-analysis suggests that robotic simultaneous resection of synchronous colorectal cancer and liver metastases may not only be feasible and safe but also may be advantageous in terms of conversion avoidance, complexity handling, and perioperative recovery.More studies with larger sample size are required to inform long-term oncological outcomes and selection criteria and to provide comparative evidence.