Background: The use of adjuvant chemotherapy in stage II colon cancer remains controversial. Identification of risk factors associated with poor outcome can help to select patients for chemotherapy. Objective: To identify clinicopathological factors predictive of systemic recurrence in patients having curative resection for stage II colon cancer. Method: A prospective review on clinical data of all patients having curative resection for stage II colon cancer in a single tertiary centre from 1996 to 2003. The primary outcome measure was systemic recurrence. Secondary outcome measures included overall survival and disease free survival. Patients were assigned to group I (no recurrence) or group II (recurrence). Analysis on survival data was performed with Kaplan Meier test.Univariate analysis was performed using log-rank test and multivariate analysis was performed using Cox proportional hazards regression model. Results: The study comprised of 315 and 61 patients in group I and II, respectively. The median age was 72 years in both groups, there was no difference in distribution of gender.The median overall survival were 39.8 months in group I and 26.5 months in group II (p < 0.001). Median disease free survival were 39.8 months and 18.5 months, respectively (p<0.001). The median number of lymph nodes harvested were 11 and 10 in group I and II, respectively (p=0.725). Three clinicopathological factors were found significant for systemic recurrence in both univariate and multivariate analyses: emergency operation (hazard ratio 2.22, 95% CI 1.27 - 3.86), anastomotic leakage (hazard ratio 3.34, 95% CI 1.27 - 8.77) and perineural permeation (hazard ratio 3.01, 95% CI 1.23 - 7.25). Other factors included in analysis but not significant were resection margin < 5cm, T stage, differentiation of tumour, lymphovascular permeation, presence of mucin and signet ring cells. Conclusion: Adjuvant chemotherapy may be offered to patients operated in emergency setting, complicated by anastomotic leakage or whose tumour showed perineural permeation after curative resection for stage II colon cancer.