Chen Engeng, Chen Li, Zhang Wei
Department of Colorectal Surgery, Sir Run Run Shaw Hospital of Zhejiang University School of Medicine, Hangzhou, China.
Front Oncol. 2025 Apr 7;15:1502014. doi: 10.3389/fonc.2025.1502014. eCollection 2025.
Colorectal cancer (CRC) remains a formidable global health challenge, ranking among the most prevalent malignancies and a principal contributor to cancer-associated mortality. While traditional open surgery has historically been the cornerstone of CRC treatment, the advent of minimally invasive techniques, particularly robotic-assisted colorectal surgery (RACS), has garnered significant momentum owing to technological advancements in the field. Robotic platforms, exemplified by the da Vinci Surgical System, offer superior three-dimensional visualization, enhanced dexterity, and heightened precision, yielding improved perioperative outcomes, particularly in anatomically intricate regions such as the pelvis. This review provides a critical appraisal of the current landscape of RACS, emphasizing its superiority over conventional open and laparoscopic approaches. The increased control and precision afforded by robotic surgery have been shown to optimize outcomes in complex procedures such as total mesorectal excision, with evidence indicating reduced intraoperative blood loss, shortened hospital stays, and improved functional recovery. Nonetheless, challenges persist, including absence of haptic feedback, prohibitive costs, and steep learning curve associated with robotic systems. Despite these limitations, RACS has demonstrated considerable promise in sphincter-preserving and function-preserving procedures, ultimately enhancing postoperative quality of life. Beyond the surgical field, this review also investigates the integration of robotic surgery within multidisciplinary treatment strategies for CRC, particularly in the context of locally advanced rectal cancer. The combination of robotic techniques with total neoadjuvant therapy and immunotherapy-especially in tumors characterized by mismatch repair deficiency or high microsatellite instability has shown notable clinical efficacy. Furthermore, emerging personalized therapeutic approaches, including immunotherapies and targeted chemotherapeutic agents, emphasize the transformative potential of RACS in delivering superior oncologic outcomes. Looking towards the future, innovations in robotic platforms, including intraoperative imaging, artificial intelligence, and augmented reality, herald new possibilities for further enhancing the precision and efficacy of colorectal surgeries. The standardization of RACS protocols, alongside ongoing training and robust clinical research, will be critical to fully realizing the benefits of these advancements across diverse clinical settings. By incorporating cutting-edge technologies and personalized treatment methods, robotic-assisted surgery is prepared to become a cornerstone in future of CRC management, with the potential to significantly improve both survival outcomes and patient quality of life.
结直肠癌（CRC）仍然是一项严峻的全球健康挑战，是最常见的恶性肿瘤之一，也是癌症相关死亡率的主要贡献因素。虽然传统的开放手术一直是CRC治疗的基石，但由于该领域的技术进步，微创技术的出现，尤其是机器人辅助结直肠手术（RACS），已经获得了显著的发展势头。以达芬奇手术系统为代表的机器人平台提供了卓越的三维可视化、增强的灵活性和更高的精度，产生了更好的围手术期结果，特别是在骨盆等解剖结构复杂的区域。本综述对RACS的当前状况进行了批判性评估，强调了其相对于传统开放和腹腔镜手术方法的优越性。机器人手术提供的更高的控制和精度已被证明可以优化复杂手术（如全直肠系膜切除术）的结果，有证据表明术中失血减少、住院时间缩短和功能恢复改善。尽管如此，挑战依然存在，包括缺乏触觉反馈、成本高昂以及与机器人系统相关的陡峭学习曲线。尽管存在这些限制，RACS在保留括约肌和保留功能的手术中已显示出相当大的前景，最终提高了术后生活质量。除了手术领域，本综述还研究了机器人手术在CRC多学科治疗策略中的整合，特别是在局部晚期直肠癌的背景下。机器人技术与全新辅助治疗和免疫治疗的结合——特别是在以错配修复缺陷或高微卫星不稳定性为特征的肿瘤中——已显示出显著的临床疗效。此外，新兴的个性化治疗方法，包括免疫疗法和靶向化疗药物，强调了RACS在提供卓越肿瘤学结果方面的变革潜力。展望未来，机器人平台的创新，包括术中成像、人工智能和增强现实，预示着进一步提高结直肠手术精度和疗效的新可能性。RACS方案的标准化，以及持续的培训和强大的临床研究，对于在不同临床环境中充分实现这些进展的益处至关重要。通过结合前沿技术和个性化治疗方法，机器人辅助手术准备成为未来CRC管理的基石，有可能显著改善生存结果和患者生活质量。
