In primary tumors of the colon, the presence of locoregional and distant metastasis has important consequences for the prognosis and the preferred treatment approach for the individual patient. 1 In the absence of clinical and radiological suspicion of distant metastasis, treatment will be surgical with curative intent in virtually all cases. If lymphatic disease is also absent in the surgical resection specimen, adjuvant therapy is rarely required and most patients will only need regular follow-up to monitor recurrence.Colonic malignancies have a tendency to spread to the pericolic lymphatics, followed by more distant lymph node stations, with distant hematologic spread usually seen as a last stage of dissemination. These steps are however not obligatorily sequential, nor is lymphatic spread a prerequisite of distant metastasis, as hematologic spread can occur in the absence of involved lymph nodes, even in necropsies. 2 Distant metastatic spread is present in about one in five patients at baseline, 3 most often to the liver, followed by the lungs and the peritoneum. Less typical sites of metastasis once colonic tumor cells reach the systemic arterial circulation are numerous and include the bones and bone marrow, the brain, and more rarely other parts of the gastrointestinal tract, as well as other solid organs including the kidney, the spleen, and adrenal glands.Despite being studied in detail, most of the research aimed at identifying patterns of metastasis combine patients affected by cancers of the colon and rectum. 4 If colonic malignancies are studied separately, it will commonly be done by clustering all regions of the colon together.Considering that lymphovascular drainage passes through distinct and anatomically discrete vessels for right-sided, left sided and sigmoid tumors, it could potentially have a significant impact on the specific rates and patterns of metastatic spread. Our aim in this study is to verify whether metastasis patterns differ for each of the major resection regions in malignancies of the colon.