A Retrospective Study Regarding the Implementation of Laparoscopy in Colon Cancer Through the Evaluation of Lymph Node Yield and Oncological Safety Margins in a Medium-Volume Center in Eastern Europe

<b>Background:</b> Laparoscopic surgical procedures are increasingly adopted for colorectal cancer because of their advantages in perioperative outcomes. However, their implementation in medium-volume centers (<50 laparoscopic resections per year) remains limited. <b>Methods:</b> A retrospective study was conducted on 274 patients undergoing colorectal cancer surgery between January 2021 and June 2025. Of these, 71 (25.91%) underwent laparoscopic surgical procedures (LS) and 203 (74.09%) open surgical procedures (OS). Primary and secondary endpoints included lymph node yield, resection margin distance, tumor stage, and hospital stay. <b>Results:</b> The mean lymph node yield was significantly higher in the open surgical procedure group (19.74 ± 10.63) compared to the laparoscopic group (16.09 ± 5.71, <i>p</i> < 0.05). Patients with significant cardiopulmonary disease or prior abdominal surgery were more often directed to open surgery, introducing selection bias that may explain differences in lymph node yield and hospital stay independent of surgical technique. The resection margin distance was significantly greater in laparoscopic cases (5.68 ± 3.12 mm) than in open procedures (4.76 ± 4.47 mm, <i>p</i> < 0.01). Hospital stay was significantly shorter in the laparoscopic group (7.14 ± 2.32 days) compared to the open group (13.17 ± 6.76 days, <i>p</i> < 0.001). A statistically significant difference in tumor staging was also observed between surgical approaches (<i>p</i> < 0.01), with earlier-stage tumors more likely treated laparoscopically. <b>Conclusions:</b> In a medium-volume center, laparoscopic surgical procedures provided comparable oncologic outcomes and superior perioperative benefits relative to open surgery, despite being more frequently performed for early-stage tumors. These findings support the safe adoption of laparoscopic colectomy outside high-volume academic settings, provided appropriate case selection and technical standards are maintained.