Table 2.

Controversial issues involving mini-invasive (laparoscopic and robotic) surgical strategies for colorectal cancer with synchronous resectable liver metastases

Controversial issue	Advantages	Disadvantages
Mini-invasive vs open colorectal surgery	Achieves better perioperative results; achieves similar oncological results	In case of rectal resection, may determine a higher risk of suboptimal oncological results at histopathology; in case of rectal resection, its overall impact on oncological outcomes is still uncertain
Mini-invasive vs open liver surgery	Achieves better perioperative results; achieves at least similar oncological results; rapid technological evolution; rapid growth of surgical experience and skill	Usually preferred for limited disease, in favourable locations and selected patients; may determine more complex and longer procedures; may determine more extended hepatectomies; less frequently used for major LR, including TSH and ALPPS, and for CRLM in postero-superior segments and in the caudate lobe; may determine higher costs
Mini-invasive vs open simultaneous colorectal and liver resection	Achieves better perioperative results; achieves similar oncological results	Usually preferred for limited liver disease, in favourable locations, and higly selected patients; may determine more complex and longer procedures; may determine higher costs
Mini-invasive vs open PSLR	Achieves better perioperative results; achieves similar oncological results; rapid technological evolution; rapid growth of surgical experience and skill	The principles of PSLR are time-consuming and rather difficult to apply during mini-invasive procedures; usually preferred for limited disease, in favourable locations and selected patients; may determine more complex and longer procedures; may determine higher costs
The impact of PSLR on mini-invasive simultaneous resection	May achieve better perioperative results; may achieve similar oncological results	May determine more complex and longer procedures; may have very limited indications

LR: Liver resection; TSH: Two-stage hepatectomy; ALPPS: Associating liver partition and portal vein ligation for staged hepatectomy; CRLM: Colorectal liver metastases; PSLR: Parenchymal-sparing liver resection.