Background: For patients with localized colon cancer, surgical resection is the only curative treatment modality. Old age may be an independent factor associated with decreased receipt of surgery. We conducted this study to evaluate the utilization of surgery and its impact on survival in older patients with colon cancer in the United States. Methods: Surveillance, Epidemiology and End Results Database (SEER-18) was utilized to identify elderly patients (≥65 years) diagnosed from 2004-2013 with non-metastatic colon cancer (stage≤ III). Study population was divided into various cohorts based on race (Caucasian, African Americans, others), sex and age (< 80 years and ≥80 years), histology grade, tumor side, and stage. Multivariate logistic regression model was utilized to assess factors associated with receipt of surgery. Kaplan-Meier estimators with the log rank test was used to compare median overall survival (Md OS) between the surgery arm and non-surgery arm. Statistical significance was defined for p < 0.05. Results: Database identified 89,467 patients (54.7% female, 82.7% Caucasian; Median age 77 years). 94.6% (n = 84,656) of patients received surgery. On multivariate-analysis, left sided disease, lower grade tumor, lower stage, female gender, residents of lower median household income county, African Americans and age ≥80 years were less likely to receive surgery. The Md OS in the surgery arm was 87 months vs 69 months for non-surgery arm, p < 0.001. This benefit was seen in all the three stages (stage I: Md OS 104 vs 75 months; stage II: Md OS 88 vs 50 months; stage III: Md OS 74 vs 37 months, p < 0.001 for all comparisons). Additional analysis for octogenarians (age≥ 80 years) showed Md OS of 68 months in the surgery arm vs 48 months in the non-surgery arm, p < 0.001). Conclusions: Our study showed significant utilization of surgery (94.6%) in elderly patients with localized colon cancer. There is a clear survival benefit to surgery even in patients with age≥ 80 years. Surgical resection with curative intent should be strongly considered in patients with good performance status irrespective of age.