Patients with inflammatory bowel disease (IBD) are at increased risk of colorectal cancer. In cases of invisible or non-endoscopically resectable dysplasia found at colonoscopy, total proctocolectomy with ileal pouch anal anastomosis can be offered with good long-term oncological outcomes and pouch survival, however, little is known regarding cancer-related outcomes when dysplasia is found incidentally after surgery. We hypothesized incidental colorectal dysplasia is associated with worse oncologic outcomes compared to dysplasia diagnosed preoperatively.