Purpose(s) - To report on the current usage of bowel preparation in elective Colorectal Cancer (CRC) patients with colonic lesion resections. To describe the incidence of complications and survival outcomes in patients receiving and not receiving bowel preparation respectively.Methods - Data were analysed from a novel dataset created for all colorectal cancer (CRC) patients in the west of Scotland from 2001 to 2005. Only patients undergoing routine or urgent operations for colon cancer (ICD10 C18X) were selected. Emergency patients were excluded from this analysis. Kaplan Meier survival curves were constructed and subsequent Cox multiple regression modelling was undertaken.Results - A total of 2348 CRC patients underwent routine or urgent operations. 1198 (51.0%) male and 1150 (49.0%) female. Age range 71. Mean age 70.28. Std deviation 10.77. There was no significant difference in complications rates for anastomotic leak, intra-abdominal abscess and fistula formation in both sets of patients when adjusting for age, Dukes’ stage and sex. Kaplan Meier survival curves demonstrate a significant (Log Rank p<0.000) 5 year survival benefit for patients receiving bowel prep. This is further explored with Cox regression analysis.Conclusions - Trends in use of mechanical bowel preparation in the West of Scotland compare well with those elsewhere in Europe. Recommendations regarding use of bowel prep remain inconclusive. We have demonstrated no statistically significant difference in complication rates between the two groups. We also report that despite adjusting for age, stage, and sex there is poorer survival in those patients not receiving bowel preparation. This adds further evidence to the ongoing debate surrounding bowel preparation in elective primary resections for colonic lesions.