A high quality perioperative colonoscopy (HQPC) before surgery or within 6 months following colorectal cancer (CRC) resection is recommended. The ESGE recommends post-surgery endoscopic surveillance 1 year after intent-to-cure CRC resection. The two main targets of endoscopic surveillance are early diagnosis of metachronous lesions and/or intraluminal recurrence of the index cancer. Few studies have shown low to no risk of early CRC in multiple cohorts with the systematic use of perioperative colonoscopy. Data on the risk factors for high rish metachronous lesions (HRML) are limited and often conflicting. Our aims are to evaluate the impact of a HQPC in the presence of HRML after CRC resection and determine risk factors for HRML during follow-up.