BackgroundThe clinicopathological features, surgical outcomes, and long-term survival of patients with young-onset colon cancer (≤ 40 years old) remain controversial.MethodsThe clinicopathologic and follow-up data of patients aged < 40 years with colon cancer between January 2014 and January 2022 were reviewed. The primary objectives were clinical features and surgical outcomes. Long-term survival was investigated as a secondary objective.ResultsSeventy patients were included in the study, and no significant rising trend (Z=0,P=1) of these patients was observed over the 8-year study period. Stage IV disease was accompanied by more ulcerative or infiltrating type (84.2% vs. 52.9%,P=0.017) and lymphovascular or perineural invasion (64.7% vs. 25.5%,P=0.003) than stage I–III disease. After a median follow-up time of 41 months (range 8–99 months), the 1-, 3-, and 5-year estimated overall survival (OS) rates were 92.6%, 79.5%, and 76.4%, respectively. The 1-, 3-, and 5-year progression-free survival (PFS) rates were 79.6%, 71.7%, and 71.7%, respectively. Multivariate Cox regression showed that M+ stage (hazard ratio [HR], 3.942; 95% confidence interval [CI], 1.176–13.220,P=0.026) was the only independent risk factor affecting OS. Meanwhile, tumor deposits (HR, 4.807; 95% CI, 1.942–15.488,P=0.009), poor differentiation (HR, 2.925; 95% CI, 1.012–8.454,P=0.047), and M+ stage (HR, 3.540; 95% CI, 1.118–11.202,P=0.032) independently affected PFS.ConclusionsThe differences in the clinical features, surgical outcomes, and long-term survival between young adults and elderly colon cancer patients need further investigation.