Application and use of artificial intelligence in colorectal cancer surgery: where are we?

AI is revolutionizing the landscape of colorectal cancer (CRC) surgery, permeating diverse facets ranging from intraoperative guidance to predictive modeling of postoperative outcomes. This scoping review aims to comprehensively delineate the breadth of artificial intelligence (AI) applications in CRC surgery. A search of PubMed, Embase, and Ebsco databases up to December 2023 was conducted, with registration in the international prospective register of systematic reviews (PROSPERO) (CRD42024502107). Sixty-two studies meeting stringent inclusion criteria were scrutinized, encompassing AI utilization in CRC surgery or the development of AI-driven tools for colorectal surgical practice. Five principal domains of AI application emerged: (i) Intraoperative guidance, leveraging real-time navigation, indocyanine green (ICG) angiography, and hyperspectral imaging (HSI) to enhance surgical precision; (ii) Image segmentation, facilitating phase recognition, tools recognition, and anatomical identification to optimize surgical visualization; (iii) Training and performance assessment, enabling objective evaluation and enhancement of surgical skills through AI-driven simulations and feedback mechanisms; (iv) Prediction of surgical complications, encompassing prognostication of anastomotic leakage (AL) or stricture, stoma requirements, and prediction of low anterior resection syndrome (LARS) and short-term postoperative complications; (v) Utilization of electronic health records (EHRs), harnessing AI algorithms to streamline data analysis and inform decision-making processes. This review underscores the paradigm-shifting impact of AI in CRC surgery, transcending conventional boundaries and catalyzing advancements across diverse surgical domains. Although many applications are still experimental, as AI continues to evolve, it promises to transform surgical practice, optimize outcomes, and revolutionize patient care. Embracing AI technologies is imperative for colorectal surgeons to remain at the vanguard of surgical innovation and deliver superior outcomes for CRC patients.