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Issues surroundings the safety and efficacy of palliative laparoscopic resections for patients with stage IV colorectal cancer have not been explicitly examined in the literature. We describe our experience with laparoscopic procedures for patients with stage IV incurable symptomatic colorectal cancer and compare perioperative outcomes with a contemporaneous group of patients who underwent conventional open procedures.We retrospectively reviewed data from laparoscopic resections performed in patients for symptomatic stage IV colorectal cancer between 1999 and 2009. Data regarding patient demographics, perioperative morbidity and mortality, intraoperative blood loss, operative time, length of postoperative hospital stay, and time from surgery to chemotherapy were assessed.A total of 29 patients were identified and of these patients, 11 (38%) underwent palliative laparoscopic resections and 18 (62%) underwent conventional open resection for stage IV colorectal cancer. In comparing laparoscopic to conventional procedures, the length of postoperative hospital stay in the laparoscopic resection group was significantly shorter than that in the open resection group (median, 17 vs. 20 d, P<0.05). Significant differences were present between the 2 groups when following features were compared: leukocyte on day 1 (median, 7.87 vs. 8.70×109/L) and day 3 (median, 6.40 vs. 7.80×109/L), albumin level on day 7 (median, 38.0 vs. 29.8 g/L), and C-reactive protein level on day 7 (median, 0.6 vs. 2.8 mg/dL). There were no significance differences between the 2 groups in intraoperative blood loss (median, 105 vs. 155 mL), operative time (median, 271.5 vs. 187.5 min), time to intake of solid food (median, 4 vs. 4 d), the rate of postoperative complications, perioperative mortality, or a duration from surgery to chemotherapy (median, 22 vs. 28 d).Palliative laparoscopic resection is a safe and feasible option with acceptable morbidity and mortality in patients with stage IV colorectal cancer. Importantly, in this group of difficult-to-treat patients, our results compare favorably with those from previously published reports on open procedures.