BACKGROUND The efficacy of laparoscopic surgery for the treatment of T3-T4a colon cancer remains a subject of debate in the medical community. AIM To explore the surgical techniques, perioperative outcomes, follow-up results, patient prognosis, and survival status associated with laparoscopic surgery for T3-T4a colon cancer. METHODS A total of 202 patients with T3-T4a colon cancer treated at the Affiliated Hospital of Hebei University between January 2020 and December 2024 were selected for this study and divided into two groups based on the type of surgery: Open surgery group (101 cases) and laparoscopic surgery group (LAP group, 101 cases). Perioperative indicators (surgical time, postoperative drainage, first flatus, hospital stay, intraoperative blood loss, and number of lymph nodes removed), disease-free survival, and overall survival at 1-year and 3-year follow-ups, as well as the incidence of complications, were compared between the two groups. RESULTS The LAP group had longer surgical times and a greater number of lymph nodes removed compared to the open surgery group (P < 0.05). The LAP group also had less blood loss, shorter drainage time, faster time to flatus, and a lower incidence of complications compared to the open surgery group (P < 0.05). There was no significant difference in hospital stay, disease-free survival, or overall survival between the two groups during the follow-up period, and this remained true even after adjusting for subgroups based on left-sided colon, right-sided colon, and T4a stage (P > 0.05). CONCLUSION The long-term outcomes of laparoscopic radical surgery for T3-T4a colon cancer are comparable to those of open surgery and can accelerate patient recovery and reduce the risk of short-term complications, offering better immediate outcomes.