Open, Laparoscopic, and robotic approaches in colorectal surgery: a comprehensive review with focus on colorectal...

BACKGROUND: Colorectal cancer (CRC) remains one of the most prevalent malignancies worldwide, and surgery continues to serve as the cornerstone of curative treatment. Over the past decade, open, laparoscopic, and robotic-assisted techniques have been widely adopted, yet the comparative effectiveness, safety, and clinical value of these approaches remain inconsistent across the literature. To address this gap, we conducted a comprehensive analytical narrative review integrating clinical, surgical, pathological, economic, and patient-centered outcomes. METHODS: A total of 184 eligible studies published between 2010 and 2025 were identified through structured database searching and a multi-stage screening process conducted by a trained research team. All included studies were systematically coded across eight major outcome domains using a standardized framework. Each article was further classified using a four-tier evidence-level system (high, moderate, low, very-low). Data were extracted into structured Excel files and synthesized descriptively across clinical, intraoperative, pathological, cost-related, learning-curve, and quality-of-life outcomes. RESULTS: Laparoscopic surgery was consistently associated with improved short-term outcomes compared with open surgery, including reduced postoperative pain, shorter hospitalization, and faster return of bowel function. Robotic-assisted surgery showed comparable—or selectively improved—clinical outcomes relative to laparoscopy, particularly reduced conversion rates and enhanced maneuverability in anatomically challenging rectal procedures. Pathological and long-term oncologic outcomes were generally similar between robotic and laparoscopic approaches. Economic analyses revealed substantially higher procedural costs for robotic surgery, despite occasional partial cost offsets in high-volume centers. Quality-of-life findings were heterogeneous, with no consistent superiority of any single surgical approach. Evidence regarding learning curves suggested potential ergonomic advantages of robotic platforms, although results varied by institutional experience and surgeon proficiency. CONCLUSION: Open, laparoscopic, and robotic-assisted colorectal surgeries each offer distinct benefits and limitations. Current evidence supports comparable or selective advantages of laparoscopic over open surgery for short-term recovery metrics, while robotic surgery may provide technical and ergonomic advantages in selected patients—particularly those with high BMI or complex pelvic anatomy. However, heterogeneous evidence, high costs, and limited long-term comparative data restrict broad adoption of robotic techniques. Large-scale multicenter trials with standardized outcomes are needed to better define the optimal surgical approach for CRC management.