Purpose: To assess the clinical and financial impact of surgery in patients with a previous colorectal cancer whose colon surveillance stopped at age 75. Methodology: Retrospective review of the Otago Clinical Audit database at Dunedin Hospital. To identify the incidence of surgery for metachronous colorectal neoplasia (MCRN) all operations between January 2020 to November 2021were reviewed. To assess morbidity and cost, patients with two resections for CRN between 2000 and 2021 were also identified. MCRN≥75 cases were compared to first colorectal neoplasia (FCRN) cases ≥75 with and without propensity matching. MCRN≥75 cases were also compared to all other colorectal resections with and without matching. Results: 18 of 237 (7.6%) patients had a MCRN, 14 (5.8%) were ≥75. 55 patients had MCRN≥75, 93 FCRN≥75 and 130 were <75. Median(IQR) age for MCRN≥75 was 81(78-86). Comparison of MCRN≥75 v FCRN≥75: MCRN cases were more morbid with a complication rate of 70.9%v50.5%, p=0.024, stay of 9v7 days, p=0.012, readmissions of 20%v6.5%, p=0.026 and a greater cost of approximately 7,000 NZD, p=0.028. Comparison of MCRN≥75 v all other cases demonstrated these same differences were all increased. An analysis removing transabdominal rectal resections (as patients with rectal cancer <75 had more rectal anastomoses) confirmed the same differences, and a non-significant 9 minute longer operating time in MCRC≥75. The annual cost for MCRN≥75 was NZD317,777. Conclusion: MCRN≥75 accounted for 5.8% of our operations and costed NZD 318,000 per annum. MCRN≥75 surgery had more morbidity and cost than FCRN≥75 and ‘all other’ colorectal resections. Stopping surveillance at 75 comes with significant institutional cost and patient morbidity.