Treatment and survival of patients with solid cancers have been improved over the last years. Two of the major goals and challenges for various cancers including colorectal, stomach, breast and other tumors are: local control by appropriate surgery alone or plus chemoradiotherapy [1–4] and personalized adjuvant systemic treatment through molecular and genetic biomarkers [5–8].

Laparoscopic surgery has been increasingly adopted into clinical practice, mostly to improve the quality of life (QOL) of patients with gastrointestinal cancer. However, there is no evidence that it improves also survival rates. Perhaps, low anterior rectal resection with total mesorectal excision (TME) represents a field in which the laparoscopic approach might lead to better local control, disease-free survival, and overall survival than the open procedure.

In a recent issue of the Journal Baik et al. report on the use of the da Vinci system in rectal cancer surgery [9]. Why should this technique, beyond QOL improvement, also provide survival benefit? Why can this benefit not be obtained for other cancer sites in the gastrointestinal tract?

Total mesorectal excision (TME) has become the standard surgical procedure for localized rectal cancer [1]. The principle underlying TME is secure dissection of an avascular plane between the presacral fascia and the fascia propria of the rectum without injuring the proper fascia of the rectum [1]. This principle can better be ensured with the laparoscopic than the open approach. The da Vinci system, beyond this, provides the surgeon with a three-dimensional surgical view that permits a steadier dissection with tremor elimination and motion scaling.

Baik et al. report on safety, feasibility, and efficiency in nine patients who underwent robotic TME using four robotic arms for the treatment of mid or low rectal cancer. The facts that this technique allows a perfect TME that might also result in sparing radiation if pathological examination reveals tumor-free proper fascia of the rectum, and perhaps most importantly local recurrence reduction and improved survival, suggests that a prospective validation of this robotic technique is warranted.

Personalization in health care maximizes the benefits for society and individual patients. At the present time, this goal appears more realistic in the prevention and treatment of the inherited cancer syndromes than of the sporadic common cancers. Indeed, prophylactic surgery in carriers of mutations in mismatch-repair genes (hereditary nonpolyposis colorectal cancer or Lynch syndrome), in BRCA1/2 (hereditary breast ovarian cancer syndrome) and in CDH1 (hereditary diffuse gastric cancer syndrome) seems to be more effective than close surveillance [10–17]. Given that, with the exception of early-stage cancer [18–21], cure rates of patients with colorectal, gastric, breast, and other common solid tumors are moderate or low [22–31], appropriate preventive intervention may save the lives of many individual patients.

Although longer follow-up data after laparoscopic surgery over open traditional resection demonstrates that the benefits in QOL for colorectal cancer are limited to the early postoperative course of months or a few years, robotic surgery for rectal cancer through an excellent TME may improve local control without the addition of radiation in some selected patients. A prospective evaluation to assess whether robotic surgery may improve local recurrence and survival is warranted.