Objective To investigate the application status and dynamic trend of laparos-copic surgery for colorectal cancer (CRC) from 2020 to 2023.

Methods The real-world retrospec-tive cohort study was conducted. The clinical data of 84 634 patients with newly diagnosed primary CRC who underwent surgery at West China Hospital of Sichuan University et al, including 349 tertiary hospitals and 801 secondary hospitals in Sichuan province, between January 1, 2020, and December 31, 2023. There were 50 203 males and 34 431 females, aged (65±12) years. Data were extracted from the Sichuan Health Management Platform, covering the inpatient medical record front-page data of all secondary and above medical institutions in the province. Procedures were classified into laparoscopic surgery and open surgery based on the name of the surgical procedure. Observation indicators: (1) comparison of clinicopathological characteristics between patients with different surgical approaches; (2) follow-up and survival outcomes; (3) temporal trend analysis of the propor-tion of laparoscopic surgery. Comparison of measurement data with skewed distribution between groups was conducted using the Wilcoxon rank sum test or Kruskal-Wallis rank sum test. Comparison of count data between groups was conducted using the chi-square test. The Cochran-Armitage test was used to analyze the temporal trends of the proportion of laparoscopic surgery. The Kaplan-Meier method was used to draw survival curve and Log-rank test was used for survival analysis.

Results (1) Comparison of clinicopathological characteristics between patients with different surgical approaches: of 84 634 patients undergoing surgery for primary CRC, 58 800 cases underwent laparoscopic surgery and 25 834 cases underwent open surgery. There were significant differences in the gender, age, age groups, five major economic regions, time of colorectal cancer diagnosis, congestive heart failure, chronic obstructive pulmonary disease, mild liver disease, renal disease, acquired immunodeficiency syndrome (AIDS), Charlson comorbidity index, tumor location, tumor with metastasis, synchronous lung metastasis, synchronous liver metastasis, and histological type between patients undergoing open surgery and laparoscopic surgery (P<0.05).(2) Follow-up and survival outcomes: the 84 634 patients were followed up for (814±470) days after surgery. The follow-up time was (784±482) days of the open surgery group and (883±432) days of the laparos-copic surgery group. The 1-year overall survival rates were 86.9% (95% confidence interval as 86.7%- 87.2%) for patients undergoing open surgery, versus 93.5% (95% confidence interval as 93.2%- 93.8%) for patients undergoing laparoscopic surgery, respectively, showing significant difference in survival between the two groups (χ²=1 097.30, P<0.05). (3) Temporal trend analysis of the propor-tion of laparoscopic surgery: among 84 634 CRC patients admitted to secondary and above medical institutions in Sichuan province from 2020 to 2023, the proportion of patients undergoing laparos-copic surgery increased year by year in the overall population, as well as in subgroups stratified by gender, age groups, five major economic regions, congestive heart failure, chronic obstructive pulmonary disease, mild liver disease, renal disease, Charlson comorbidity index, colon tumor location, histolo-gical type, tumor with metastasis, synchronous lung metastasis, and synchronous liver metastasis (P<0.05).

Conclusions From 2020 to 2023, the number of male patients with CRC in Sichuan province is higher than that of female patients, and most patients are diagnosed at the age of 60-79 years.The utilization rate of laparoscopic surgery for primary CRC increases year by year among patients aged ≥80 years, with comorbidities of major chronic diseases, with tumor metastasis, and the overall population.However, there is a significant imbalance exists between colon cancer and rectal cancer surgeries.