Purpose Splenic flexure colon cancers are anatomically challenging and traditionally considered to have poorer outcomes than other colon cancers. Optimal extent of resection remains controversial. We compared survival of splenic flexure versus non splenic colon cancers and examined whether operative approach affects outcomes for splenic flexure cancers. Methodology A retrospective cohort study using the Cairns Hospital colorectal database (2019–2025) included adults undergoing resection for invasive colon adenocarcinoma, classified as splenic flexure or non splenic. Overall survival (OS) and disease free survival (DFS) were analysed using Kaplan–Meier methods and Cox models adjusted for T/N stage; a propensity matched cohort (1:3) was also examined. Within the splenic flexure subgroup, operations were grouped as left hemicolectomy/colectomy, extended right hemicolectomy and subtotal colectomy. A PRISMA guided systematic review summarised survival by tumour site and operative approach. Results Among 401 colon cancers, 27 (6.7%) arose at the splenic flexure. Baseline and stage characteristics were similar to non-splenic cases. Three year OS was 82.5% versus 85.8%, and DFS 77.8% versus 81.5%, respectively. Splenic flexure location was not associated with OS (adjusted hazard ratio [HR] 1.14, 95%CI 0.41–3.19) or DFS (HR 1.21, 95%CI 0.48–3.04), including in matched analyses. Within splenic flexure cancers (n=27), left hemicolectomy/colectomy (n=16), subtotal colectomy (n=6) and extended right hemicolectomy (n=2) achieved similar survival; subtotal colectomy had longer length of stay and higher lymph node harvest. The review (>5,000 patients) showed no consistent survival disadvantage for splenic flexure cancers and no oncological benefit of extended resections. Conclusion Splenic flexure colon cancers had survival comparable to other colon cancers in this regional cohort. Extended resection offered no oncological benefit and should be reserved for complex or emergency cases.