The Future of Surgery Opened by Robotic-Assisted Techniques in Colorectal Cancer

Robotic-assisted surgery (RAS) is rapidly transforming colorectal cancer treatment. RAS became widely adopted after reimbursement for rectal cancer was approved in 2018 and for colon cancer in 2022. By 2024, RAS accounted for 31% of rectal and 9% of colon cancer surgeries. Compared to conventional laparoscopic surgery (LS), RAS offers reduced intraoperative blood loss, shorter hospital stays, fewer complications, and improved recovery, though often with longer operative times. Recent randomized controlled trials demonstrated RAS's superiority in short-term outcomes for rectal cancer, surpassing previous findings, as surgical expertise and technology advanced. A key indicator of surgical quality, the circumferential resection margin (CRM), is difficult to assess under traditional Japanese pathology methods. To address this, a novel semi-opened circular specimen processing method was developed, enabling CRM evaluation and international comparison. A multicenter study (VITRUVIANO, 2024) found that RAS had a lower CRM positivity rate (4.6%) compared to LS (8.6%), supporting its oncological safety. Despite higher upfront costs, RAS may reduce overall hospital costs in high-volume, experienced centers, as shown in several economic analyses. Clinical outcome data from the ROSEMARY trial led to the inclusion of differential reimbursement rates for advanced RAS procedures in Japan's healthcare system from 2024. As robotic systems diversify globally with technological innovations, surgeon preference remains a major driver of adoption. Continued evaluation through long-term outcomes and cost-effectiveness studies will be essential to optimizing RAS in future colorectal cancer care.