Introduction: The aim of this study is to evaluate the associated patient and tumor related characteristics in patients undergoing surgery for cancer complicating inflammatory bowel disease (IBD) and to assess differences between patients with Crohn’s disease (CD) and ulcerative colitis (UC).Methods: Data of all IBD patients with colon and rectal cancer (CRC) undergoing surgery were evaluated from prospectively maintained CRC and IBD databases. Clinical presentation, tumor stage, presence of associated dysplasia and short and long term outcomes after surgery were investigated. Results: 240 IBD patients (64 CD and 176 UC) with CRC were identified. At time of CRC diagnosis, 66% UC and 26% CD patients had pancolitis. 90.5% (n=199 out of 220) of the patients who underwent preoperative colonoscopy were noted to have suspicious lesions (mass: 68.2%, polyp: 15%, stricture: 3.2% and chronic fistula or ulcer: 3.2%). Colitis at endoscopy (n=16) was indication for surgery in 7.3%. Colonoscopy was normal in 4 cases (1.8%). 91% patients had a preoperative pathological diagnosis of cancer or dysplasia. Synchronous dysplasia was seen in 45% vs synchronous cancer in 14%. Tumor site was the rectum in 36.7%, right colon in 27.6%, sigmoid colon in17.2%, transverse colon 9.9% and left colon in 8.6% of patients. 70 % of patients were enrolled in a colonoscopic surveillance program. Cancer stage (p=0.9) and long term cancer outcomes (p=0.5) were comparable for patients who were or were not under colonoscopic surveillance. When comparing the long term outcomes for IBD patients with CRC to sporadic CRC patients, a comparable local recurrence rate and overall 5 year survival rate were documented (5.6% vs 6.7%, p=0.78 and 77% vs 72%, p=0.5, respectively). CD patients were diagnosed at more advanced cancer stage. Local cancer recurrence rate was similar for both(p=0.7). Conclusions: Diagnosis of CRC in IBD patients is associated with a new endoscopic finding in most patients. Long term cancer outcome is comparable to sporadic CRC.