Int J Colorectal Dis (2012) 27:1077–1085 DOI 10.1007/s00384-012-1424-8 ORIGINAL ARTICLE Survival following laparoscopic versus open resection for colorectal cancer Wai Lun Law & Jensen T. C. Poon & Joe K. M. Fan & Oswens S. H. Lo Accepted: 16 January 2012 / Published online: 9 February 2012 # The Author(s) 2012. This article is published with open access at Springerlink.com Abstract Background This study aimed to compare the overall and disease specific survivals of patients who underwent lapa- roscopic and open resection of colorectal cancer in a high volume tertiary center. Methods Consecutive patients who underwent elective resec- tion for colorectal cancer (open resection, n01,197; laparo- scopic resection, n0 814) from January 2000 to December 2009 were included. The operative details, postoperative com- plications, postoperative outcomes, and survival data were collected prospectively. Comparison was made between patients who had laparoscopic and open surgery. Results The age, gender, medical morbidity, and American Society of Anesthesiologists status were similar in the two groups. Laparoscopic resection was associated with signifi- cantly less blood loss and a shorter hospital stay. The operating mortality and morbidity were significantly lower in the lapa- roscopic group. The qualities of the specimens in terms of the distal resection margin and the number of lymph nodes exam- ined were not inferior in the laparoscopic group. With the median follow-up of 40.3 months, the 5-year overall survival (74.1% vs. 65.5%, p<0.001) and disease specific survival (81.9% vs. 75.2%, p 0 0.002) were significantly better in patients with non-disseminated disease in the laparoscopic group. The operative approach was an independent prognostic factor in the overall (risk ratio 1.36, 95% CI 1.093–1.700, p0 0.006) and disease specific (risk ratio 1.32, 95% CI 1.005– 1.738, p0 0.048) survivals in multivariate analysis. No funding or financial relationships to claim. W. L. Law (*) : J. T. C. Poon : J. K. M. Fan : O. S. H. Lo Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong, Hong Kong e-mail: lawwl@hkucc.hku.hk Conclusion Laparoscopic resection for colorectal cancer is associated with more favorable overall and disease specific survivals when compared with open resection in a high volume tertiary center. Keywords Outcomes of laparoscopic colorectal resection Introduction Colorectal cancer is one of the most common malignancies in Western countries [1] and its incidence has also risen in Asian countries. Currently it is the second most common cancer and second leading cause of cancer death in Hong Kong [2]. Surgical resection has remained the mainstay treatment for colorectal cancer. However, the operation is a major undertaking and is associated with significant mor- bidity, especially is elderly patients with concomitant med- ical conditions. Laparoscopic resection has been reported to improve the short-term outcomes in terms of less postoper- ative pain and analgesic requirement, quicker recovery and a shorter hospital stay [3–6]. Data from randomized trials comparing open and laparoscopic colon resection also dem- onstrated that survival after laparoscopic resection was not inferior to open resection [7–10]. Whether the advantage of fewer complications and better short-term outcomes can be translated to a better survival in patients with cancer is controversial. More favorable survival in patients who under- went laparoscopic resection has been demonstrated in a ran- domized trial [10] and a population study [11]. We previously also reported better overall survival in patients who underwent laparoscopic colon and rectal resection in series of smaller number of patients [12, 13]. In this study, we would like to confirm the findings with a cohort of larger number of patients with longer follow-up. The current study aimed to evaluate the