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OBJECTIVE The aim this study was to compare the stage-for-stage overall (OS) and recurrence free (RFS) survival between adult and pediatric/adolescent colon cancer patients. METHODS A retrospective review of pediatric/adolescent patients < 25 years old treated between 1991 and 2017 at University of Texas MD Anderson Cancer Center, was compared with a prospectively maintained database of adult patients. Outcome variables were compared and OS and RFS were estimated using the Kaplan-Meier method and compared between groups using the log rank test and multivariable Cox models. RESULTS The cohort was 94 pediatric patients and 765 adult patients. Overall, the 3-year OS rate for adult and pediatric patients respectively was 90% and 41.92% (95% CI:87%-92%)(p < 0.0001), and the 3-year RFS rate was 78% and 32% (p < 0.0001). The stage-for-stage 5-year OS rates for adult vs pediatric patients were: Stage 1-96% vs 100% (p=0.793); Stage 2-90% vs 64%(p<0.0001); Stage 3-85% vs 58%(p<0.0001); Stage 4-55% vs 16% (p<0.0001). The stage-for-stage 5-year RFS rates for adults vs children were: Stage 1-95% vs 100%; Stage 2-85% vs 55% (p=0.0002); Stage 3-73% vs 31% (p<0.0001); Stage 4-27% vs 5%(p<0.0001). Pediatric/adolescent patients had a higher risk of recurrence or death than adult patients on multivariate analysis (HR=2.312, 95% CI:1.615-3.313 (p<0.0001). Peritoneal metastasis was significantly higher in pediatric patients. (p=0.00001) CONCLUSIONS: Stage-for-stage, pediatric/adolescent patients had shorter 3- and 5-year OS and RFS rates than adult patients. Peritoneal disease and carcinomatosis was significantly higher in pediatric, adolescent and young adult patients less than 25 years. Pre-disposing conditions such as polyposis or congenital colon disease did not contribute to this difference.