1084 We are not the only group, which reported superior survival in laparoscopic resection. Lacy et al. reported better survival in laparoscopic resection in a single center randomized trial and the better survival was mainly in the group of patients with stage III cancer [10]. Capussotti et al. also found that in patients with stage III colon cancer laparoscopic resection was associated with a significantly disease free and cancer related survival [20]. We also demonstrated better overall survival in stage II and stage III cancer. In the study by Bilimora et al. using the National Cancer data, better survival was found in the patients with laparoscopic surgery [11]. In case of rectal cancer, Laurant et al. also demonstrated better survival in patients with laparoscopic resection, but there was no differ- ence in cancer free survival [21]. Thus improvement of sur- vival can be achieved with the laparoscopic approach. One of the reasons accounting for the better survival might be the better immunological response in patients who under- went laparoscopic surgery. This has been demonstrated in many studies on the inflammatory markers after laparoscopic surgery [22, 23]. The association of cytokines such as inter- leukin 6 and VEGF, which was produced significantly more after open surgery, with tumor recurrence has been demon- strated in animal models. The less release of cytokines such as interleukin 6 and VEGF in the postoperative period has been demonstrated in laparoscopic surgery [24]. This might also contribute to the better oncologic outcome in laparoscopic resection. Moreover, the lower complication rate associated with laparoscopic resection might also contribute to the better survival. Khuri and colleagues showed with the NSQIP data that the presence of postoperative complications adversely affected the long-term survival of patients in eight operations, which included colorectal resection [25]. The presence of postoperative complications has also been demonstrated to affect the survival of patients who underwent resection for colorectal, esophageal and liver cancer [26–29]. Thus the lower complication rate associated with laparoscopic resection might be the reason accounting for the better survival. This is exemplified by Lacy et al.’s trial in which a significant lower complication rate as well as better survival were demonstrated in the patients with laparoscopic resection. Admittedly, the study is not a randomized trial and biases in the selection of patients for laparoscopic procedures were unavoidable. It could be shown that there were more patients with earlier cancer in the laparoscopic group. The size of the tumor was also larger in the open group. How- ever, other parameters including the distal resection margin as well as the number of lymph nodes examined were not inferior in laparoscopic resection. The surgical approach remained an independent significant factor associated with for better survival. Moreover, the difference in survival between the laparoscopic and open resection could be dem- onstrated in analysis according to the stage of the disease. This study also highlighted the impact of laparoscopic Int J Colorectal Dis (2012) 27:1077–1085 resection on the outcomes of treatment of colorectal cancer in a high volume center. With the wider application of laparoscopic resection for colorectal malignancy worldwide, it is expected that more data from large volume centers or from population studies can give more information on the impact of survival with the shift to laparoscopic surgery. 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