OBJECTIVE: Whether family history (FH) of colorectal cancer (CRC) affects survival in patients with CRC remains controversial. We examined the association between FH of CRC and cancer recurrence and survival in patients with CRC. METHODS: Between April 2001 and December 2007, 971 patients with CRC were enrolled and retrospectively analysed. RESULTS: Of these, 63 (6.5%) reported CRC in a first-degree relative. Death occurred in 12.7% (8/63) in CRC patients with family history and 21.8% (198/908) in those without family history. Multivariate analysis of patients with Stage III CRC, compared with patients without FH of CRC, found that the adjusted hazard ratios (HR) of those with first-degree relatives with CRC were 0.674 (p=0.281) for overall survival (OS) and 0.672 (p=0.220) for disease-free survival (DFS). However, tumour location, preoperative carcinoembryonic antigen (CEA) level, tumour (T) stage and lymph node (N) status significantly affected OS and DFS in Stage III CRC. Furthermore, whereas FH of CRC was associated with a favourable prognosis in Stage III colon cancer (HR=0.224; p=0.040), it was not in rectal cancer (HR=1.225). CONCLUSION: In patients Stage III CRC, tumour location (especially in the rectum), high CEA level and advanced T and N stages indicate a poor prognosis. However, in Stage III colon cancer, FH is associated with improved survival.