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The aim of this study was to compare theprognosis of rectal cancer among patients with and without a synchronous colon cancer.Our nationalprospective cohort included all 9635 rectal cancer patients diagnosed between 1993 and 2004 in Norway.Altogether, 327 (3.4%) rectal cancer patients had a synchronous colon cancer; 121 (37%) were situatedproximal and 206 (63%) distal to the splenic flexure. Proximal tumours had a higher T status and lower differentiation than distal tumours. The rates of local recurrence and distant metastases were similar among radically treated patients with aproximal synchronous, distal synchronous and solitary rectal cancer. Five-year survival was 46% (95% CI 35-57), 56% (95% CI 48-64) and 63% (95% CI 62-65), respectively (log-rank P < 0.001). Median survival following distant metastases was seven, 12 and 17 months, respectively.Patients with aproximal synchronous colon cancer had inferior survival than patients with a solitary rectal cancer.