OBJECTIVES: Laparoscopy is a safe and effective approach to the treatment of colon cancer. However, the effects of laparoscopy on short- and long-term health outcomes and overall medical utilization have yet to be fully elucidated. The study aims to compare short- and long-term medical care utilization with health outcomes in a population-based cohort. METHODS: Retrospective analysis was conducted by linking the Taiwan Cancer Registry data to National Health Insurance claims data and the Death Registry data to compare laparoscopy and open surgery with regard to outcomes and costs. Patients with colon cancer aged 18 and older between January 1, 2009 and December 31, 2012 were included in the study. Propensity score matching was used to minimize selection bias between groups. We examined 30-day mortality and 1-year mortality after surgery; complications within 30 days, length of stay, medical utilization, and overall health care costs for the index hospitalization for 30 , 90 , 180 and 365 days after surgery. RESULTS: Among the 11,269 colon cancer patients who underwent colectomy during the period of study, 3,236 (28.72%) received laparoscopy and 8,033 (71.28%) underwent open surgery. Compared with open surgery, laparoscopy was associated with lower 30-day mortality (0.44% vs 0.91%), lower 1-year mortality (2.83% vs 4.68%), lower overall occurrence of complications (6.16% vs 8.77%), shorter mean length of stay (12.53 vs 14.93 day), and lower cost for index hospitalization (US$4325.34 vs US$4453.90). No significant differences were observed in medical utilization over a period of 365 days after surgery, including outpatient visits, hospitalization, and overall costs, (all P >.05). CONCLUSIONS: Laparoscopic surgery is no more expensive than open surgery for colon cancer in the short- and long-term postoperative period. Laparoscopic surgery also reduces the likelihood of postoperative complications and improves the chances of survival.