Safety of Simultaneous Robot-Assisted Resection of Colorectal Malignancy and Synchronous Liver Metastases

Introduction: Simultaneous resection of primary colorectal malignancies and liver metastases resulted in outcomes comparable to those achieved through a two-stage procedure, while offering the advantage of a single surgical intervention. The role of the robotic approach remains underexplored because of the lack of comprehensive evidence. The objective of our study was to examine the safety of the robotic surgical platform, assess its short-term outcomes, and compare them with those of open procedures. Methods and Material: We retrospectively analyzed data from an initial small series of eight consecutive patients treated at the UMC Ljubljana between March 2023 and December 2025. These patients underwent robot-assisted simultaneous resection of colorectal malignancies and liver metastases. Their outcomes were compared with those of an open cohort of eight patients. Results: The median operative time was 334 min (range, 193-415 min). No conversions or transfusions were required. Three patients experienced severe complications, accounting for 37.5% of the cohort. The median duration of hospitalization was 9.5 days. The median number of lymph nodes retrieved was 22. Complete (R0) resection of the primary tumor was achieved in all cases (100%), whereas resection of the liver was achieved in 87.5% of the cases. Importantly, there were no instances of re-hospitalization within 30 days or mortality within 90 days. Conclusions: Although the rate of severe complications is relatively high, the robotic surgical platform allows for the safe simultaneous resection of colorectal malignancies and liver metastases, achieving short-term outcomes comparable to those of open surgery.