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Minimally Invasive Surgery in Gastrointestinal Oncology: Laparoscopy and Robotics in Colorectal Cancer - A Literature Review up to 2025

Cirug�a m�nimamente invasiva en oncolog�a gastrointestinal: laparoscopia y rob�tica en c�ncer colorrectal: una revisi�n bibliogr�fica hasta 2025

Cirurgia minimamente invasiva em oncologia gastrointestinal: laparoscopia e rob�tica no cancro colorretal - Uma revis�o da literatura at� 2025

 

Mar�a Fernanda Piedra Cevallos II maferpiedra2009@gmail.com https://orcid.org/0009-0004-7415-6945           �

Angie Pauleth Su�rez Correa I angiesr88@gmail.com https://orcid.org/0009-0002-0306-0458

Milton Antonio Sambonino Espinoza III miltonsambonino@gmail.com https://orcid.org/0009-0008-8478-1794               �

Wendy Gisel Pachacama O�a IV wendygisel1117@gmail.com https://orcid.org/0000-0002-8765-9013

 

 

 

 

 

 

 

 

 

Correspondencia: angiesr88@gmail.com

 

Ciencias de la Salud

Art�culo de Investigaci�n

 

* Recibido: 26 de octubre de 2025 *Aceptado: 24 de noviembre de 2025 * Publicado: 04 de diciembre de 2025

 

       I.          Medical Doctor; Independent Researcher; Queens New York 11368, USA

      II.          Surgical Doctor; Independent Researcher; Quito, Ecuador

    III.          Surgical Doctor; Student at Prep Step 1; New Jersey, USA

    IV.          Medical Doctor; Independent Researcher; Quito, Ecuador

 

 

Abstract

This systematic review, conducted following PRISMA guidelines, compares the oncological efficacy, perioperative outcomes, morbidity, and cost-effectiveness of laparoscopic and robotic approaches in the surgical treatment of Colorectal Cancer (CRC), utilizing high-level evidence published between 2015 and 2025. Databases such as PubMed, Scopus, and Cochrane were searched. Priority was given to including Randomized Controlled Trials (RCTs), systematic reviews, and meta-analyses comparing minimally invasive surgery (Lap/Rob) with open surgery, or robotic surgery with laparoscopic surgery, in CRC patients. Key metrics evaluated included Overall Survival (OS), Disease-Free Survival (DFS), conversion rate, length of hospital stay, and functional outcomes (urinary dysfunction and ileus). Laparoscopic surgery is the cost-effective standard for colon cancer, maintaining oncological safety and offering superior recovery compared to open surgery. Robotic surgery finds its niche in rectal cancer, where functional benefits and the reduction of the risk of conversion to open surgery justify its higher cost, particularly in high-volume centers and in the hands of surgeons who have completed the learning curve. The future is centered on the integration of artificial intelligence to standardize surgical quality and mitigate the challenges of the learning curve and global accessibility.

Keywords: Colorectal Cancer; Laparoscopic Surgery; Robotic Surgery; Total Mesorectal Excision; Survival; Quality of Life; Learning Curve.

 

Resumen

Comparar la eficacia oncol�gica, los resultados perioperatorios, la morbilidad y la relaci�n costo-efectividad de los abordajes laparosc�pico y rob�tico en el tratamiento quir�rgico del c�ncer colorrectal (CCR), utilizando evidencia de alto nivel publicada entre 2015 y 2025. Se realiz� una revisi�n sistem�tica, siguiendo las gu�as PRISMA, en bases de datos como PubMed, Scopus, �Cochrane, entre otras. Se prioriz� la inclusi�n de ensayos cl�nicos aleatorizados (ECAs), revisiones sistem�ticas y metaan�lisis que comparasen la cirug�a m�nimamente invasiva (Lap/Rob) con la cirug�a abierta, o la rob�tica con la laparoscopia, en pacientes con CCR. Las m�tricas clave evaluadas incluyeron la supervivencia global (SG), la supervivencia libre de enfermedad (SLE), la tasa de conversi�n, la estancia hospitalaria y los resultados funcionales (disfunci�n urinaria e �leo).

La cirug�a laparosc�pica es el est�ndar costo-efectivo para el c�ncer de colon, manteniendo la seguridad oncol�gica y ofreciendo una recuperaci�n superior a la cirug�a abierta. La cirug�a rob�tica encuentra su nicho de valor en el c�ncer de recto, donde los beneficios funcionales y la reducci�n del riesgo de conversi�n a cirug�a abierta justifican su mayor costo, particularmente en centros de alto volumen y en manos de cirujanos con la curva de aprendizaje completada. El futuro se centra en la integraci�n de la inteligencia artificial para estandarizar la calidad quir�rgica y mitigar los desaf�os de la curva de aprendizaje y la accesibilidad global.

Palabras claves: C�ncer Colorrectal; Cirug�a Laparosc�pica; Cirug�a Rob�tica; Excisi�n Mesorrectal Total; Supervivencia; Calidad de Vida; Curva de Aprendizaje.

 

Resumo

Comparar a efic�cia oncol�gica, os resultados perioperat�rios, a morbilidade e a rela��o custo-benef�cio das abordagens laparosc�pica e rob�tica no tratamento cir�rgico do cancro colorretal (CCR), utilizando evid�ncia de alto n�vel publicada entre 2015 e 2025. Foi conduzida uma revis�o sistem�tica, seguindo as diretrizes PRISMA, em bases de dados como a PubMed, Scopus e Cochrane, entre outras. Foi dada prioridade � inclus�o de ensaios cl�nicos randomizados (ECRs), revis�es sistem�ticas e meta-an�lises que comparassem a cirurgia minimamente invasiva (Lap/Rob) com a cirurgia aberta, ou a cirurgia rob�tica com a laparoscopia, em doentes com CCR. As principais m�tricas avaliadas inclu�ram a sobreviv�ncia global (SG), a sobreviv�ncia livre de doen�a (SLD), a taxa de convers�o, o tempo de internamento hospitalar e os resultados funcionais (disfun��o urin�ria e �leo).

A cirurgia laparosc�pica � o padr�o custo-efetivo para o cancro do c�lon, mantendo a seguran�a oncol�gica e oferecendo uma recupera��o superior em compara��o com a cirurgia aberta. A cirurgia rob�tica encontra o seu nicho no cancro do reto, onde os benef�cios funcionais e o menor risco de convers�o para cirurgia aberta justificam o seu custo mais elevado, particularmente em centros de alto volume e quando realizada por cirurgi�es que j� conclu�ram a curva de aprendizagem. O futuro reside na integra��o da intelig�ncia artificial para uniformizar a qualidade cir�rgica e mitigar os desafios da curva de aprendizagem e da acessibilidade global.

Palavras-chave: Cancro colorretal; Cirurgia laparosc�pica; Cirurgia rob�tica; Excis�o total do mesorreto; Sobrevida; Qualidade de vida; Curva de aprendizagem.

Introduction

Global Burden of Colorectal Cancer and Justification

Colorectal Cancer (CRC) remains one of the malignant neoplasms with the highest incidence and mortality globally, presenting a significant health burden. Surgery continues to be the pillar of potentially curative treatment for CRC (1). The American Cancer Society (ACS) continues to publish estimates highlighting the changing trends and notable patterns of the disease, even in the year 2024, signaling the persistence of this oncological challenge (2). The clinical relevance of this pathology justifies the continuous search for therapeutic methods that not only maintain rigorous oncological standards but also minimize surgical trauma and accelerate recovery.

The historical evolution of surgical treatment for CRC has marked significant progress, from traditional open resections towards minimally invasive approaches (3). This transition has been based on the premise that less surgical trauma leads to lower morbidity, less blood loss, and consequently, faster postoperative recovery (1).

The primary justification for this review lies in the need to synthesize the most recent evidence, spanning the period 2015-2025, to critically compare the outcomes, safety, and future perspectives of the two main minimally invasive approaches: laparoscopic surgery and robotic surgery.

 

Historical Evolution: From Open Surgery to the Robotic Era

The introduction of laparoscopic surgery in CRC revolutionized surgical practice. Initially, its adoption was cautious, especially in the context of malignant disease, due to concerns about long-term oncological safety, particularly regarding the possibility of tumor dissemination at port sites or the adequacy of resection compared to the open approach (3). However, large randomized controlled trials (RCTs) have consistently established the non-inferiority of laparoscopic surgery in terms of overall survival (OS) and disease-free survival (DFS) compared to open surgery (1).

Despite the standardization of laparoscopy, especially for colon cancer, technical limitations persisted in the treatment of lesions located in the rectum. Total Mesorectal Excision (TME), a key procedure for rectal cancer, demands precise dissection in the narrow pelvic space, a task made difficult by the two-dimensional (2D) vision and the limited freedom of movement of rigid laparoscopic instruments (4).

The advent of robotic surgery, personified by the Da Vinci system, sought to overcome these shortcomings. Robotic technology offers magnified three-dimensional (3D) visualization and superior dexterity of articulated instruments (similar to the human wrist), allowing for finer and more precise dissection (5). This precision was immediately considered advantageous in rectal cancer surgery to optimize TME and potentially improve the preservation of pelvic autonomic nerves (6).

In this context, recent evidence up to 2025 confirms that minimally invasive surgery (whether laparoscopic or robotic) has demonstrated equivalent or even slightly superior oncological outcomes to open surgery (1). The current debate, therefore, has shifted from oncological equivalence to the optimization of patient-centered outcomes, including morbidity, functional recovery, and cost-effectiveness. This implies that the research no longer questions whether MIS works, but whether the additional functional and perioperative benefits of the robot justify its higher cost.

 

Methodology

Study Design and Sources

The present study is a narrative review that employs systematic search criteria, following the principles of the PRISMA statement. The objective was to identify, evaluate, and synthesize high-level evidence related to laparoscopic and robotic approaches in colorectal cancer.

The information sources consulted covered key academic and scientific databases: PubMed, Scopus, Web of Science, ScienceDirect, and Cochrane. The search period was intentionally delimited between 2015 and 2025, allowing for the capture of long-term survival studies subsequent to the large randomized trials that validated laparoscopy, and capturing the rapid expansion and maturation of the robotic platform in the last decade. Articles published in both English and Spanish were included.

 

Inclusion and Exclusion Criteria

The inclusion criteria encompassed Randomized Controlled Trials (RCTs), systematic reviews, meta-analyses, and clinical guidelines. The target population was adult patients with colorectal cancer, specifically those undergoing surgical resection via the laparoscopic or robotic approach.

Studies on open surgery that did not include a comparative group with a minimally invasive approach were explicitly excluded. Similarly, case reports, letters to the editor, and grey literature or non-academic reviews were discarded in order to maintain the scientific rigor and robustness of the synthesized evidence.

Table 1. Results of the search and selection strategy.

 

 

 

 

 

 

 

 

Figure 1. PRISMA 2020 Flow Diagram for Updated Systematic Reviews Including Database, Register, and Other Source Searches.

To contextualize the review, a summary of the high-impact studies that define the body of evidence analyzed is presented.

 

 

 

 

 

 

 

 

Table 2. Summary Table of Included Studies

Table 3. International Guidelines and Consensus Documents

Organization	Guideline/Version (2020-2025)	Colon Cancer Recommendation	Rectal Cancer Recommendation
NCCN	Colon Cancer V5.2025	Laparoscopy and Robotics are preferred options (Category 1/2A) for curative resection.	Both approaches are accepted. Technical precision in robotic TME is recognized.
ASCO/ESMO	International Consensus (2020-2024)	Strong support for Laparoscopy due to equivalent long-term outcomes and perioperative benefits.	Laparoscopy is standard; Robotics is a validated option, prioritizing precision for functional preservation in the pelvis.

Source: NCCN (15).

Laparoscopic Surgery in Colorectal Cancer: Standardization of the Minimally Invasive Approach

Oncological Safety: The Scientific Consensus

Laparoscopic surgery has been consolidated as the standard approach for colon cancer and a viable option for rectal cancer, demonstrating that it does not compromise fundamental oncological principles. Recent meta-analyses comparing Minimally Invasive Surgery (MIS, including laparoscopy and robotics) with open surgery report that both techniques have equivalent rates in terms of oncological adequacy. This includes achieving R0 resection (negative surgical margins) and an adequate lymph node yield (generally defined as the extraction of ≥12 lymph nodes), which are essential metrics for accurate staging and a good prognosis (1, 8).

In terms of long-term outcomes, the evidence is compelling. A joint analysis of studies indicates that MIS shows results equivalent to open surgery in Overall Survival (OS), with an overall Hazard Ratio (HR) of 0.99. Similarly, Disease-Free Survival (DFS) is considered equivalent to open surgery for Stage II and III colorectal cancer, with an overall HR of 0.96. It is important to note that some observational studies have even reported a slight advantage in 5-year DFS with MIS, such as in one report that found a DFS of 71.0% compared to 50.3% in open surgery (1). This consistency in oncological outcomes, validated by guidelines such as the NCCN V5.2025 (15), positions laparoscopy as a preferred and Category 1/2A option for the curative resection of colon cancer.

Although oncological safety for colon cancer is well-established, rectal cancer (RC) historically presented greater technical challenges via the laparoscopic route. However, long-term survival in RC patients operated on laparoscopically continues to be subject to analysis and confirmation, and the consensus is that, with adequate technique and sufficient experience, oncological safety is maintained (10).

Perioperative Outcomes and Morbidity

The advantages of laparoscopy over open surgery in the perioperative period are indisputable and constitute the main reason for its massive adoption. Early postoperative morbidity is significantly lower with the minimally invasive approach (7.1%) compared to open surgery (44.8%) (1).

Among the most notable benefits are:

Hospital Stay: The length of hospitalization is consistently reduced. Recent studies report an average stay of 7.8 days for MIS compared to 14 days in open surgery (1). This reduction facilitates earlier recovery and a faster return to normal activities (11).

Complications: The incidence of Surgical Site Infection (SSI) is markedly lower in MIS (1.2%�10.4%) compared to open surgery (10.9%�44.8%). Furthermore, a lower rate of reinterventions is observed (2.9% vs. 12.2% in open surgery) (1).

The drastic reduction in postoperative morbidity, particularly in hospital stay and the prevention of complications like SSI, has a systemic economic impact. The ability to reduce the need for readmissions or stays in the Intensive Care Unit (ICU) offsets the cost of the laparoscopic procedure (1). In fact, the superiority of laparoscopy in perioperative outcomes is so marked that it should be considered the default option for uncomplicated colon cancer, due to its proven balance between oncological safety (equivalent to open) and superior recovery.

Learning Curve and Standardization

The Learning Curve (LC) in laparoscopic colorectal surgery represents a significant obstacle to widespread adoption and the replication of high-quality results. Competence is achieved after a variable number of cases; historically, 20 cases were defined for benign procedures, but the mastery of complex oncological procedures, especially laparoscopic TME in the pelvis, requires a substantially greater number, often exceeding 100 cases (11).

The challenge is compounded by the low volume of cases managed by many general surgeons. Surveys in the American Board of Surgery have revealed that the average number of colonic resections per surgeon is barely 11 procedures per year (11). This low annual volume makes it extremely difficult for the average surgeon to meet the necessary learning curve to ensure oncological quality, such as obtaining negative margins and an adequate lymph node yield, elements that have been crucial in non-inferiority studies.

This discrepancy between the LC requirement and the average surgical volume underscores the need to centralize minimally invasive oncological surgery in high-volume centers or managed by colorectal subspecialists. Standardization of technique and structured training are crucial to ensuring that the promising results of large RCTs are replicated in daily clinical practice. This implies that clinical guidelines, such as NCCN 2025, should emphasize not only the approach but also referral to specialized centers or rigorous training programs to mitigate the risk associated with technical inexperience.

Robotic Surgery in Colorectal Cancer: Platform Evaluation and Technology

Technological and Ergonomic Advances

Robotic surgery represents the most recent evolution of MIS. The Da Vinci� platform has been established as the predominant system in colorectal surgery, known as the epicenter of robotic colorectal surgery in many institutions (4).

The main advantage of the robot over conventional laparoscopy lies in its technological capabilities, which include:

3D Visualization: A magnified stereoscopic view that provides unmatched depth perception, essential for the dissection of delicate structures (4).

Articulated Instrumentation (EndoWrist): Robotic instruments replicate the movement capacity of the human wrist, allowing for superior dexterity and precise maneuverability in confined spaces, such as the narrow pelvis during a Total Mesorectal Excision (TME) (4).

The resulting precision from 3D visualization and instrument stability is fundamental, especially for technically demanding procedures like rectal resection, where high vascular ligation and splenic flexure mobilization are critical steps (6). Although the Da Vinci system dominates, the development of new robotic technologies, such as single-port procedures, continues to seek improved accessibility and reduced invasiveness, as observed in the first case of single-port robotic colorectal resection in Oregon (12).

Operative Outcomes: Operative Time and Conversion Rate

The direct comparison of operative outcomes between robotics and laparoscopy reveals a series of key trade-offs.

Operative Time (OT): Historically, operative time in robotic surgery is significantly longer than laparoscopic time (15). This is largely due to the docking time and the initial setup of the robot, which adds a non-surgical phase to the procedure. However, structured training in robotic surgery has been shown to reduce the learning curve and improve operative times, minimizing this disadvantage (7).

Conversion Rate to Open Surgery: One of the most robust and consistent benefits of robotics, especially in rectal surgery, is its lower rate of conversion to an open procedure. This advantage is clinically crucial, as conversion to open surgery is associated with an increase in postoperative complication rates and delays the interval to complete adjuvant chemotherapy (16). The robot's ability to access and maneuver in the narrow pelvis, where laparoscopy is more prone to conversion, represents a considerable value (9).

The comparison of cost and efficiency must go beyond the OT. While the robot may prolong operating room time, preventing a conversion avoids the cost associated with a much longer hospital stay, increased pain, and an elevated risk of complications, which constitutes a net gain in minimally invasive completion efficiency.

 

Comparative Analysis: Robotics vs. Laparoscopy (Focus on Rectal Cancer)

Current evidence, accumulated up to 2025, allows for a nuanced analysis of the two minimally invasive techniques, recognizing that laparoscopy remains the cost-effective standard for most colon cancers, while robotics finds its clearest niche in complex pelvic procedures.

Oncological Parameters and Long-Term Outcomes

In terms of medium- and long-term oncological efficacy, robotics has proven to be equivalent to laparoscopy. In the meta-analysis of randomized trials comparing Robotics vs. Laparoscopy for rectal cancer, no significant differences have been found in Disease-Free Survival (DFS) or Overall Survival (OS). Both approaches ensure the quality of the resection, maintaining R0 margins and an adequate lymph node yield (1).

However, the robot's precision in TME for low or mid-rectal cancer, facilitated by 3D vision and dexterity, allows for a potentially cleaner dissection in the limited space of the pelvis. Although this does not always translate into statistically significant differences in positive margins in large RCTs, it does result in superior surgical quality in terms of conversion rate (16) and functional outcomes.

Functional Outcomes and Quality of Life (QoL)

The main clinical justification for the added cost of the robot arises from the long-term functional outcomes in rectal surgery. TME requires the careful dissection of crucial pelvic autonomic nerve structures, whose injury can lead to chronic urinary and sexual dysfunction (13).

Robotic technology facilitates the preservation of these nerves. A key meta-analysis published in Surgical Endoscopy (2021), which combined data from over 24,000 patients, found clear functional advantages with robot-assisted rectal resection compared to laparoscopic surgery (16).

Urinary Retention: A lower rate of urinary retention was observed in patients operated with robotic assistance.

Postoperative Ileus: The rate of postoperative ileus was lower with the robotic approach (16).

Quality of Life: Patients reported a higher Quality of Life (QoL) in the postoperative follow-up (16).

These findings are fundamental, as they demonstrate that robotics not only maintains oncological safety but also offers better short- and medium-term functional outcomes. The ability of robotics to perform sphincter-preserving surgeries is facilitated by this precision, minimizing the need for permanent colostomies (4).

Robotics acts as a "last mile" solution in MIS. It does not seek to replace laparoscopy in all cases, but to perfect the minimally invasive approach in the most challenging anatomies, where the functional benefits and the reduction in conversion to open surgery fully justify the investment (9).

Tabla 4. Comparativa de resultados laparoscop�a vs rob�tica

Outcome Metric	Laparoscopic Surgery	Robotic Surgery	Main Advantage / Justification
Oncological Safety (DFS/OS)	Equivalent to Robotic/Open	Equivalent to Laparoscopic/Open	No significant long-term differences.
Hospital Stay	Significant reduction vs. Open	Similar to Laparoscopic	Both MIS approaches surpass open surgery in early recovery.
Conversion Rate to Open	Moderate/High in complex rectal cancer	Significantly lower	Robotic superiority in narrow pelvic dissection.
Operative Time (OT)	Shorter than Robotics (in general)	Longer (due to docking time)	Higher initial operative cost is a limitation.
Functional Outcomes (Rectum)	Variable risk of genitourinary dysfunction	Lower urinary retention, less ileus, better QoL	3D precision favors the preservation of pelvic autonomic nerves.
Cost-Effectiveness	Generally favorable (lower platform cost)	Higher initial and operative cost	Main limitation in global adoption.

Source: Feng et al; NCCN; Park et al; Quinde Su�rez et al (1, 9, 15, 16).

Recurrence Rate and Survival

The data collected up to 2025 solidify the understanding that minimally invasive approaches maintain long-term oncological consistency. Specifically, the 5-year local recurrence rate and distant recurrence rate are similar between MIS (Lap/Rob) and open surgery (1). This oncological non-inferiority is an indispensable requirement for adopting any new surgical technique in cancer treatment.

In rectal cancer, where the quality of the TME is a critical factor for local recurrence, the evidence suggests that both laparoscopy and robotics, when performed by experienced surgeons, achieve the oncological quality TME necessary for favorable long-term outcomes (10).

 

Cost-Effectiveness and Current Limitations

The economic evaluation of minimally invasive surgery presents a significant dichotomy between Laparoscopy and Robotics.

Laparoscopic Surgery has proven to be cost-effective. Although the initial cost of the instrumentation is slightly higher than that of open surgery, this investment is offset by savings derived from reduced morbidity and hospital stay (e.g., from 14 days in open to 7.8 days in MIS) (1). The lower need for readmissions or ICU stays consolidates the economic advantage of laparoscopy.

Robotic Surgery presents a greater economic challenge. It involves significantly higher costs, including the initial investment in the robotic system (Da Vinci or new systems), ongoing maintenance, and per-case consumables. This high platform cost is the main limitation to its widespread adoption (9).

However, the justification for robotic investment must take into account the functional return on investment. The reduction in the rate of conversion to open surgery avoids the costs associated with major complications and prolonged hospital stays. Furthermore, the prevention of chronic dysfunctions (urinary and sexual) and the improvement in quality of life observed with robotics translate into a reduction in long-term post-acute healthcare expenditure, although this metric is complex to integrate into traditional cost-effectiveness models (16).

Therefore, future economic evaluation studies must rigorously include Quality of Life (QoL) metrics and the costs of managing chronic pelvic dysfunction to reflect the true value of robotic precision. Ignoring functional benefits undervalues the global impact of robotic surgery on patient health and the healthcare economy.

The barriers to robotic adoption are especially notable in developing countries, where high cost, lack of infrastructure, and limited healthcare coverage act as significant limitations to implementing this advanced technology (14).

Future Perspectives and Challenges

The future of minimally invasive colorectal surgery is moving toward greater precision, personalization, and the integration of advanced technologies.

 

 

Integration of Artificial Intelligence and Automation

Artificial Intelligence (AI) and augmented vision are poised to revolutionize the robotic operating room. Although robotics already provides a high-definition 3D view (16), AI can superimpose vital information in real-time onto the surgical field. This includes visualizing nerve dissection planes, precisely delimiting tumor margins using guided fluorescence, or automated identification of critical structures (14).

The integration of AI not only assists the expert surgeon but is also fundamental for standardizing surgical quality. By monitoring the technique in real-time and guiding critical steps of the operation, AI has the potential to reduce technical variability among surgeons. This process could democratize surgical outcomes, ensuring that the oncological and functional benefits observed in centers of excellence are replicated in lower-volume settings, thereby mitigating the problems associated with the prolonged learning curve of MIS (16).

Telesurgery and Global Accessibility

The development of telesurgery and advanced virtual training systems will address the challenge of surgical training and accessibility. Telesurgery technologies will allow for remote training and mentorship in real-time, which is crucial for standardizing advanced TME techniques in centers with less experience or in isolated geographical regions (3). Advanced simulation and virtual environments will accelerate the robotic learning curve, which has been shown to reduce early complications and improve operative times in real life (7).

Nevertheless, the global implementation of these technologies faces immense challenges in developing countries. The need for robust hospital infrastructure, high cost, and lack of healthcare coverage are fundamental barriers (14). For these regions, the priority must be the consolidation of low-cost laparoscopic training and the creation of focused training programs, before considering the massive adoption of robotics.

Conclusions and Recommendations

The literature review up to 2025 confirms the oncological safety of Minimally Invasive Surgery (MIS), both laparoscopic and robotic, in the treatment of colorectal cancer, demonstrating its long-term equivalence in overall and disease-free survival compared to open surgery.

Standardization of MIS: Laparoscopic surgery should be considered the standard approach for colon cancer resection due to its proven perioperative benefits (lower morbidity, shorter hospital stay) and its favorable cost-effectiveness profile.

Refined Role of Robotics: Robotic surgery is primarily justified in the most technically demanding procedures, specifically Total Mesorectal Excision (TME) for low and mid-rectal cancer. Its distinctive advantages are a lower conversion rate to open surgery and superior functional outcomes, including a lower rate of urinary retention, less ileus, and better quality of life. These functional benefits, derived from improved precision in nerve preservation, represent the added value that justifies its high cost.

Challenge of the Learning Curve and Centralization: Given the considerable learning curve required for complex oncological MIS (100+ cases) in contrast to the low average annual volume of surgeons, centralization of these procedures in high-volume centers and the implementation of structured training programs, including virtual simulation, are recommended to standardize technical quality.

Economic Perspective: Future cost-effectiveness evaluations must evolve to include the economic impact of functional outcomes and quality of life, in addition to traditional metrics like hospital stay, in order to capture the total benefit of robotic precision.

 

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