Objective: To compare the efficacy of 3D laparoscopic and open radical resection in treatment of obstructive colorectal cancer after transanal endoscopic tube decompression. Methods: The clinical data of 96 patients with obstructive colorectal cancer undergoing surgical treatment from May 2011 to June 2013 were retrospectively analyzed. Of the patients, all cases received transanal endoscopic tube decompression before surgery, and then 50 cases underwent 3D laparoscopic radical resection for colorectal cancer (laparoscopic group) and 46 cases underwent open radical resection for colorectal cancer (open surgery group). The main clinical variables between the two groups of patients were compared. Results: The preoperative data had comparability between the two groups. In laparoscopic group versus open surgery group, the average operative time (5.9 h vs. 5.2 h, P<0.05) was prolonged and overall hospitalization cost (33 000 yuan vs. 27 000 yuan, P<0.05) was increased significantly, but the average time to postoperative gas passage (2.4 d vs. 3.0 d, P<0.05), time to postoperative urethral catheter removal (2.7 d vs. 3.9 d, P<0.05) and length of hospital stay (15.2 d vs. 23.8 d, P<0.05) were all shortened significantly. The incidences of anastomotic leakage, incision infection, intra-abdominal abscess and ileus showed no significant difference between the two groups (all P>0.05). The 3-year disease-free survival rates were not significantly different between the two groups (80.0% vs. 82.6%, P=0.744). Conclusion: For obstructive colorectal cancer after tube decompression, 3D laparoscopic surgery offers fast postoperative recovery and is similar to open surgery in terms of perioperative complications and outcomes. It can be considered as an alternative procedure for obstructive colorectal cancer.