Since there is no abstract available we provide the first paragraph
Can the laparoscopic approach improve survival of patients with colon cancer? This is a crucial question for thousands of patients and many physicians in the industrialized world. It is well-known that the laparoscopic approach improves the quality of life in the early postoperative period. But, its impact on long-term clinical outcomes is controversial. Lacy et al  in the July 2008 issue of the Annals of Surgery report on a randomized trial and conclude that laparoscopy-assisted colectomy (LAC) as compared with open colectomy (OC) for nonmetastatic colon cancer significantly improves recurrence-free and overall survival. Given the major clinical implications of this finding, if it is true, we would like to comment on whether this is a robust conclusion or, due to potential biases, this finding can be interpreted as a chance occurrence. To explain the unexpected survival superiority of LAC, particularly in advanced tumor stage, Lacy et al have dedicated all the discussion of this study  to support the hypothesis of differences in surgical stress response, cellular immunity, tumor handling, and complication rate between the 2 groups, of closed and open colectomy. However, evidence of each or all of these hypotheses is inadequate. Additionally, the authors are unable to exclude selection biases and to explain the contradictory results of all other randomized trials available.