PURPOSE: Decision of laparoscopic surgery (LS) for locally advanced colorectal cancer is based on preoperative computed tomography (CT), notwithstanding the inaccuracy of T staging. The aim of this study was to compare the differences between LS and open surgery (OS) in their R0 resection rate, short-term results, and oncologic outcomes for T4 colorectal cancer staged by preoperative CT scanning. METHODS: A total of 101 patients who had undergone LS were compared with 46 patients who had undergone OS. Preoperative CT scans for all patients indicated T4. Emergency operation, distant metastases, chemoradiotherapy, and multivisceral resection were excluded from the study. RESULTS: The OS group showed a higher percentage of right-side colon cancer (p=0.028), larger tumor (p=0.039), and postoperative complication rate (p=0.002). There was no difference in R0 resection rate between the two groups (94.1% vs. 95.7%; p=1.000). The LS group showed significantly shorter hospital stays (p=0.001), but a similar operation time (p=0.103) compared with the OS group. No significant difference in five-year overall survival, disease-free survival, and local recurrence was observed between the two groups. CONCLUSION: The results of this study show that LS is feasible in the majority of patients with T4 colorectal cancer staged by CT scanning if multivisceral resection is not planned.