# Postoperative Outcomes of Laparoscopic Versus Open Colorectal Resection for Colorectal Cancer: A Systematic Review and Meta-Analysis of Comparative Observational Cohorts

## TL;DR

This study compares laparoscopic and open surgery for colorectal cancer, finding laparoscopic surgery has better short-term outcomes like less infection and shorter hospital stays.

## Contribution

A systematic review and meta-analysis comparing laparoscopic and open colorectal cancer surgery outcomes using observational cohort data.

## Key findings

- Laparoscopic surgery was linked to lower postoperative morbidity and fewer surgical site infections.
- Patients had reduced blood loss and shorter hospital stays with laparoscopic resection.
- Operative time was longer for laparoscopic procedures, but no increased harm was observed.

## Abstract

Colorectal cancer is a major global health burden, with surgical resection remaining the cornerstone of curative treatment for non-metastatic disease. Although laparoscopic colorectal surgery is widely adopted in many settings, its short-term postoperative outcomes relative to open surgery in routine clinical practice remain variably reported. This systematic review and meta-analysis aimed to compare short-term postoperative outcomes following laparoscopic versus open colorectal resection for colorectal cancer using observational cohort evidence.

A systematic search of PubMed/Medical Literature Analysis and Retrieval System Online (MEDLINE), Scopus, Web of Science, Excerpta Medica database (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and African Journals OnLine (AJOL) was conducted for English-language comparative observational studies published between January 2013 and June 2025, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies included adult patients undergoing laparoscopic or open colorectal cancer resection. Primary outcomes were overall postoperative morbidity, surgical site infection, length of hospital stay, intraoperative blood loss, and operative time. Risk of bias was assessed using standardized criteria, and random-effects meta-analyses were performed when outcomes were reported in at least two methodologically comparable studies; otherwise, findings were synthesized narratively.

Six observational studies encompassing 2,295 patients met the inclusion criteria. Compared with open surgery, laparoscopic resection was associated with lower postoperative morbidity, fewer surgical site infections, reduced blood loss, and shorter hospital stays, while operative time was longer. Some pooled comparisons reached statistical significance, whereas others did not. Moderate heterogeneity was observed across outcomes, likely reflecting differences in study design, patient selection, and institutional practice. Sensitivity analyses did not materially alter the direction of findings.

Overall, this systematic review suggests that laparoscopic colorectal surgery is associated with favorable short-term postoperative outcomes in observational settings, without a clear signal of increased perioperative harm. However, the certainty of evidence is moderate due to the observational nature of the data and between-study heterogeneity, and results should be interpreted accordingly.