Comparative Outcomes of Open Versus Laparoscopic Colon Surgery: A Propensity Score-Matched Analysis of Postoperative Complications, Recovery Times, and Long-Term Survival

Background Open and laparoscopic colon surgeries are both common interventions for benign and malignant colonic diseases. Evidence regarding their comparative effectiveness on postoperative and long-term outcomes remains mixed. This study aimed to evaluate differences in complications, recovery times, and survival between the two approaches using propensity score matching to reduce selection bias. Methods A retrospective cohort study was conducted on 600 patients undergoing colon surgery: 218 (36.3%) open, 168 (28.0%) laparoscopic, and 214 (35.7%) robotic-assisted procedures. Mean age was 56 years (range: 18-88), with an equal sex distribution. Indications included benign disease (51.7%) and malignancy (48.3%), predominantly Stage III colorectal cancer (56.5%). Outcomes included postoperative complications, pain scores, length of stay (LOS), and mortality. Results Postoperative complications occurred in 80% of patients, most frequently deep vein thrombosis (21.5%), anastomotic leak (19.8%), and infection (19.3%), with no significant difference between surgical groups (p = 0.493). Laparoscopic surgery resulted in significantly lower pain scores (mean: 4.5 versus 5.7; p = 0.009, Cohen's d = 0.23) and shorter LOS (mean: 4.2 versus 6.3 days; p = 0.011, Cohen's d = 0.38) compared to open surgery. Thirty-day mortality rates were similar across groups (p = 0.633). Cardiovascular disease (HR = 2.01, p = 0.004), diabetes (HR = 1.85, p = 0.008), and lower socioeconomic status were significant predictors of long-term mortality and prolonged recovery. Conclusion Laparoscopic colon surgery offers significant short-term advantages in pain reduction and hospitalization length but does not reduce complication rates or improve long-term survival compared to open surgery. Comorbidities and socioeconomic disparities have greater influence on long-term outcomes than surgical technique.