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Cancers
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Robotic Surgery for Gastrointestinal (GI) Malignancies
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Robotic Surgery for Gastrointestinal (GI) Malignancies

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Clinical Research of Cancer".

Deadline for manuscript submissions: 31 August 2025 | Viewed by 5971

Special Issue Editors

Dr. Yaron Rudnicki

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Guest Editor
Meir Medical Center, Department of Surgery, Faculty of Medicine, Tel Aviv University, Kfar Saba 4428164, Israel
Interests: robotic surgery for colorectal cancer
Prof. Dr. Shmuel R. Avital

E-Mail Website
Guest Editor
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6139001, Israel
Interests: laparoscopic; laparoscopic surgery; rectum tumor; colorectal surgery
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Robotic-assisted surgery for GI malignancies, including colorectal, upper GI, liver, and pancreas, has become common practice in many centers around the world. As more robotic platforms are introduced into practice, costs are being driven down, and the field of minimally invasive surgical oncology is being revolutionized at a fast-growing pace.

Surgical robots have been in use for almost two decades, though there are very little data showing any advantages to laparoscopy. Having said that, in the last couple of years, there has been a rise in high-quality academic studies that have shown measurable advantages in robotic surgery in terms of metrics such as length of stay, SSI, readmissions, conversion rates, lower rates of complications, and the wellbeing of the patient and the surgeon.

Operating on different GI malignancies requires specialized training, and so does minimally invasive surgery. Some disciplines have adopted robotic surgery full-heartedly, like colorectal surgery, valuing the robotic approach for pelvic surgery, and others are still learning where and how to utilize these robotic platforms, as is the case in liver and pancreas surgery.

This Special Issue of Cancers will investigate the role of robotic surgery in treating various gastrointestinal cancers and will feature new articles and reviews focused on the implementation of robotic surgery, "how to do it", and its advantages.

Dr. Yaron Rudnicki
Prof. Dr. Shmuel R. Avital
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • robotic surgery
  • colorectal cancer
  • gastric cancer
  • liver cancer
  • pancreatic cancer
  • esophageal cancer
  • robotic platform

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Published Papers (5 papers)

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Research

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13 pages, 2723 KiB  
Article
Combined TaTME with SP Robot for Low Anterior Resection in Rectal Cancer: rSPa TaTME
by Nouran O. Keshk, Mauricio E. Perez-Pachon, Ibrahim Gomaa, Sara Aboelmaaty, David W. Larson, Kristen K. Rumer and Sherief F. Shawki
Cancers 2025, 17(8), 1328; https://doi.org/10.3390/cancers17081328 - 15 Apr 2025
Viewed by 617
Abstract
Background: Total mesorectal excision (TME) remains the gold standard for the resection of rectal cancer regardless of the modality: open, laparoscopic, or robotic. The transanal TME (TaTME) approach has been utilized to overcome the difficulties encountered with the dissection of tumors in [...] Read more.
Background: Total mesorectal excision (TME) remains the gold standard for the resection of rectal cancer regardless of the modality: open, laparoscopic, or robotic. The transanal TME (TaTME) approach has been utilized to overcome the difficulties encountered with the dissection of tumors in the distal pelvis. Recently, a single-port robotic approach (rSPa) was introduced, where three arms and a camera emanate from a 2.5 cm diameter port. This report presents the first experience in the United States combining those two approaches (rSPa TaTME) in rectal cancer, evaluating its safety and oncologic outcomes. Methods: This is a retrospective review of our prospectively maintained rectal cancer database. Patient demographics, tumor characteristics, neoadjuvant treatment, and oncologic and surgical outcomes were recorded. Results: Between May 2022 and August 2024, ten patients (six females, four males) with a median age at surgery of 53 years (range: 38–85) and a mean BMI of 26 (±5) kg/m2 were included for analysis. The median distance of tumors from the anorectal junction was 3.2 cm (range: 2–5.3 cm). All patients had negative margins, with eight complete TME specimens, one near complete, and one incomplete. The mean number of lymph nodes harvested was 24 (±11). The average operative time was 351 (243–411) min. The average length of stay was four days. The ileostomy was reversed in nine out of ten patients. Six patients experienced complications within 30 days of surgery. There were no local or distal recurrences, with a mean follow-up of 20 months (range: 4–30). Conclusions: rSPa TaTME is a unique and innovative method of combining two minimally advanced approaches for the resection of distal rectal cancers, with acceptable surgical and oncologic outcomes. Full article
(This article belongs to the Special Issue Robotic Surgery for Gastrointestinal (GI) Malignancies)
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11 pages, 236 KiB  
Article
Colorectal Cancer Outcomes of Robotic Surgery Using the Hugo™ RAS System: The First Worldwide Comparative Study of Robotic Surgery and Laparoscopy
by Giacomo Calini, Stefano Cardelli, Ioana Diana Alexa, Francesca Andreotti, Michele Giorgini, Nicola Maria Greco, Fiorella Agama, Alice Gori, Dajana Cuicchi, Gilberto Poggioli and Matteo Rottoli
Cancers 2025, 17(7), 1164; https://doi.org/10.3390/cancers17071164 - 30 Mar 2025
Viewed by 1167
Abstract
Background/Objectives: The aim of the study was to compare the perioperative and oncologic outcomes of patients who underwent surgery for colorectal cancer (CRC) performed using laparoscopy or using the Medtronic Hugo™ Robotic-Assisted Surgery (RAS) system. Methods: This is a retrospective comparative single-center [...] Read more.
Background/Objectives: The aim of the study was to compare the perioperative and oncologic outcomes of patients who underwent surgery for colorectal cancer (CRC) performed using laparoscopy or using the Medtronic Hugo™ Robotic-Assisted Surgery (RAS) system. Methods: This is a retrospective comparative single-center study of consecutive minimally invasive surgeries for CRC performed by two colorectal surgeons with extensive laparoscopic experience at the beginning of their robotic expertise. Patients were not selected for the surgical approach, but waiting lists and operating room availability determined whether the patients were in the robotic group or the laparoscopic group. The primary outcome was to compare 30-day postoperative complications according to the Clavien–Dindo classification and the Complication Comprehensive Index (CCI). The secondary outcomes included operating times, conversion rates, intraoperative complications, length of hospital stays (LOS), readmission rates, and short-term oncologic outcomes, such as the R0 resection, the number of lymph nodes harvested, the total mesorectal excision (TME) quality, and the circumferential resection margin (CRM). Results: Of the 109 patients, 52 underwent robotic and 57 laparoscopic CRC surgery. Patient demographic and clinical characteristics were similar in the two groups. There was no significant difference between the robotic and the laparoscopic groups regarding postoperative complications, the Clavien–Dindo classification, and the CCI. They also had similar operating times, conversion rates, intraoperative complications, LOSs, readmission rates, and short-term oncologic outcomes (the lymph nodes harvested, the R0 resection, TME quality, and CRM status). Conclusions: This study reports the largest cohort of CRC surgery performed using the Medtronic Hugo™ RAS system and is the first comparative study with laparoscopy. The perioperative and oncologic outcomes were similar, demonstrating that the Medtronic Hugo™ RAS system is safe and feasible for CRC as compared to laparoscopic surgery, even at the beginning of the robotic experience. Full article
(This article belongs to the Special Issue Robotic Surgery for Gastrointestinal (GI) Malignancies)
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17 pages, 2226 KiB  
Article
Robotic Rectal Cancer Surgery: Perioperative and Long-Term Oncological Outcomes of a Single-Center Analysis Compared with Laparoscopic and Open Approach
by Shachar Laks, Michael Goldenshluger, Alexander Lebedeyev, Yasmin Anderson, Ofir Gruper and Lior Segev
Cancers 2025, 17(5), 859; https://doi.org/10.3390/cancers17050859 - 2 Mar 2025
Cited by 1 | Viewed by 1536
Abstract
Background/Objectives: Robotic-assisted surgery is an attractive and promising option with unique advantages in rectal cancer surgery, but the optimal surgical approach is still debatable. Therefore, we aimed to compare the short- and long-term outcomes of the robotic-assisted approach with the laparoscopic-assisted and open [...] Read more.
Background/Objectives: Robotic-assisted surgery is an attractive and promising option with unique advantages in rectal cancer surgery, but the optimal surgical approach is still debatable. Therefore, we aimed to compare the short- and long-term outcomes of the robotic-assisted approach with the laparoscopic-assisted and open approaches. Methods: A single referral center in Israel retrospectively reviewed all patients that underwent an elective rectal resection for primary non-metastatic rectal cancer between 2010 and 2020. The cohort was separated into three groups according to the surgical approach: robotic, laparoscopic, or open. Results: The cohort included 526 patients with a median age of 64 years (range 31–89), of whom 103 patients were in the robotic group, 144 in the open group, and 279 patients in the laparoscopic group. The robotic group had significantly more lower rectal tumors (24.3% versus 12.7% and 6%, respectively, p < 0.001), more locally advanced tumors (65.6% versus 51.2% and 50.2%, respectively, p = 0.004), and higher rates of neoadjuvant radiotherapy (70.9% versus 54.2% and 39.5%, respectively, p < 0.001). Conversion to an open laparotomy was more common in the laparoscopy group (23.1% versus 6.8%, respectively, p = 0.001). The open approach had higher rates of intraoperative complications (23.2% compared with 10.7% and 13.5% in the robotic and laparoscopic groups, respectively, p = 0.011), longer hospital stays (10 days compared with 7 and 8 days, respectively, p < 0.001), and higher rates of postoperative complications (76% compared with 68.9% and 59.1%, respectively, p = 0.002). The groups were similar in the number of harvested lymph nodes (14) and the incidence of positive resection margins (2.1%). The 5-year overall survival in the robotic group was 92.3% compared with 90.5% and 88.3% in the laparoscopic and open groups, respectively (p = 0.12). The 5-year disease-free survival in the robotic group was 68% compared with 71% and 63%, respectively (p = 0.2). Conclusions: The robotic, laparoscopic, and open approaches had similar histopathological outcomes and long-term oncological outcomes. The open approach was associated with higher rates of perioperative morbidity. These findings suggest that the robotic approach is safe and effective in rectal cancer surgery. Full article
(This article belongs to the Special Issue Robotic Surgery for Gastrointestinal (GI) Malignancies)
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10 pages, 1306 KiB  
Article
Serosal Patching with Glubran®2 on the Pancreatic Stump for Reducing Postoperative Pancreatic Fistulae After Robot-Assisted Distal Pancreatectomy: A Single-Center Retrospective Study
by Ahmad Mahamid, Eden Gerszman, Esther Kazlow, Aasem Abu Shtaya, Natalia Goldberg, Dvir Froylich and Riad Haddad
Cancers 2025, 17(3), 502; https://doi.org/10.3390/cancers17030502 - 3 Feb 2025
Viewed by 765
Abstract
Background: Postoperative pancreatic fistulae (POPFs) are a significant cause of morbidity following left pancreatectomy. We hypothesized that incorporating serosal patching with the application of a synthetic sealant, a modified cyanoacrylate (Glubran®2), to the pancreatic stump, would decrease the incidence rate of [...] Read more.
Background: Postoperative pancreatic fistulae (POPFs) are a significant cause of morbidity following left pancreatectomy. We hypothesized that incorporating serosal patching with the application of a synthetic sealant, a modified cyanoacrylate (Glubran®2), to the pancreatic stump, would decrease the incidence rate of clinically significant POPFs. Methods: This is a retrospective study of consecutive patients who underwent robot-assisted left pancreatectomy. The primary outcome was clinically significant POPFs within 90 days of surgery. Secondary outcomes included the incidence rate of POPFs (all the grades), 90-day morbidity, and 90-day mortality. Results: We compared outcomes between Glubran®2 sealant with serosal patching (GSP, n = 6) and Glubran®2 sealant without serosal patching (GNSP, n = 12) groups. The GSP group had significantly lower incidence rates of clinically significant POPFs (grades B/C) (p = 0.034) and overall POPFs (all the grades) (p = 0.046). No significant differences in 90-day postoperative morbidity were observed between the two groups (p = 0.56), and no 90-day mortality occurred in either group. Conclusions: Incorporating serosal patching along with Glubran®2 sealant in the management of the pancreatic stump during left pancreatectomy demonstrates promising results in reducing the incidence rate of clinically significant POPFs. This finding highlights the need for further research with larger sample sizes in order to confirm the observed outcomes and explore the long-term implications for postoperative complications and recovery in patients undergoing this procedure during pancreatic surgery. Full article
(This article belongs to the Special Issue Robotic Surgery for Gastrointestinal (GI) Malignancies)
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Review

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23 pages, 1672 KiB  
Review
Current Status and Future Applications of Robotic Surgery in Upper Gastrointestinal Surgery: A Narrative Review
by Koichi Okamoto, Takashi Miyata, Taigo Nagayama, Yuta Sannomiya, Akifumi Hashimoto, Hisashi Nishiki, Daisuke Kaida, Hideto Fujita, Shinichi Kinami and Hiroyuki Takamura
Cancers 2025, 17(12), 1933; https://doi.org/10.3390/cancers17121933 - 10 Jun 2025
Viewed by 1015
Abstract
Robot-assisted surgery has proven highly effective in the curative treatment of various gastrointestinal cancers. The advantages of robot-assisted surgery, including precision, enhanced operability, and magnified 3D visualization, allow surgeons to perform delicate procedures that would be challenging with conventional laparotomy or laparoscopy. These [...] Read more.
Robot-assisted surgery has proven highly effective in the curative treatment of various gastrointestinal cancers. The advantages of robot-assisted surgery, including precision, enhanced operability, and magnified 3D visualization, allow surgeons to perform delicate procedures that would be challenging with conventional laparotomy or laparoscopy. These benefits make robot-assisted surgery a viable modality for treating various malignant tumors and an essential tool in curative surgery for solid cancers. Laparoscopic gastrectomy is currently the standard treatment for early gastric cancer, with numerous clinical trials assessing the efficacy of robot-assisted surgery. Although thoracoscopic esophagectomy has demonstrated advantages over open surgery in radical esophageal cancer treatment, ongoing studies are evaluating the noninferiority and potential benefits of robotic surgery. Robot-assisted surgery is also being explored for conversion surgery in cases where radical resection becomes feasible after multidisciplinary treatment and in polysurgery cases involving multiple prior laparotomies. However, establishing robust evidence for its efficacy in radical surgery for conversion and polysurgery cases remains a challenge. This narrative review discusses the advantages and limitations of robot-assisted surgery in such complex cases based on an analysis of the literature. Additionally, it examines the prospects of robotic-assisted surgery in polysurgery, metachronous remnant gastric cancer, and conversion surgery. Full article
(This article belongs to the Special Issue Robotic Surgery for Gastrointestinal (GI) Malignancies)
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