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Perioperative blood transfusion during surgery for colorectal cancer has been shown to increase the risk of recurrence. Our hypothesis is that increased bleeding during surgery impairs oncological survival. In thepresent study, the importance of the magnitude of blood loss during surgery for colonic cancer on overall survival is evaluated.All patients undergoing surgery for colonic cancer, stage I-III, in the Uppsala-O rebro region between 1997 and 2003 were included (n = 3725). Patients dying within 6 months after surgery were excluded. Median surgical bleeding was 250 ml. Patients were stratified in three groups for type of surgery. Uni-and multivariate Cox analysis was performed.Univariate analysis: Operative bleeding > 250 ml (HR = 1.12; 1.02-1.22) and blood transfusion (HR = 1.16; 1.06-1.28) increased the risk of death while age < 75 years wasprotective (HR = 0.74; 0.68-0.81). Multivariate analysis: Stage III (HR = 1.34; 1.20-1.49) and bleeding > 250 ml (HR = 1.13; 1.02-1.25) increased risk of death, while age < 75 years wasprotective (HR = 0.66; 0.59-0.73).The study shows that blood loss during surgery for colonic cancer affect long time survival. In thepresent study, overall mortality is used as a surrogate for death in cancer.