OBJECTIVES: To assess the comparative efficiency of laparoscopic versus open surgery in colorectal cancer patients. METHODS: To establish relative efficacy of laparoscopic versus open surgery in all measures that could have clinical or economic relevance. Using previous systematic reviews and updating their contents with the new information published after. Meta-analysis technique is used to summarize the information. A Markov model is developed to estimate progress in time of health and resource use obtained with these two alternatives. Measures of health outcomes used in the model were life years and quality adjusted life years. Probabilistic sensitivity analysis was performed to assess uncertainty in the parameters included in the Markov model. RESULTS: Preliminary results show that cost of laparoscopic-assisted surgery is higher than open surgery in close to 750 €. This difference decreased slightly in the immediate postoperative period due to the lower readmission rate. The difference in costs, coupled with the equivalence in long-term results obtained by the two techniques makes that any of them can be considered efficient for our health system. Since considering a willingness to pay between 20,000 and 30,000 € per quality-adjusted life year gained, none of the alternatives have above 60% chance to be the best option. CONCLUSIONS: The laparoscopic-assisted resection has shown results in terms of overall survival and recurrence similar to those achieved by open surgery in colorectal surgery patients. The estimated cost for laparoscopic intervention is slightly higher than open surgery, but seems to accelerate the postoperative recovery time. This implies that none of the two alternatives is clearly superior to the other in terms of efficiency. Therefore, each decision maker at hospital level will assess available human and material resources, and its cost structure to use resources more efficiently.