Background – Synchronous polyps are common at diagnostic colonoscopy for suspected or confirmed colorectal cancer. Whether to remove them during the index procedure remains debated due to perceived risks (tumour seeding, bleeding, technical difficulty). In rural/regional practice, decisions are further shaped by long travel distances, limited list/anaesthetic availability, and variable access to advanced polypectomy, driving practice variation. Aim – To describe current practice and identify factors associated with performing synchronous polypectomy during diagnostic colonoscopy. Method – Cross-sectional, anonymous online survey of Royal Australasian College of Surgeons–registered general/colorectal surgeons currently performing colonoscopy in regional Australia. The instrument captures participants’ demographics and decision factors (polyp size/morphology/location, tumour proximity, anticoagulation, comorbidity, perceived oncologic risk). Primary outcome: self-reported frequency of synchronous polypectomy. Secondary outcomes: independent predictors of synchronous polypectomies as determined by multivariate logistic regression. A subgroup analysis was used to identify the relationship between subspecialty interest and trend to perform synchronous polypectomy. Results – In a regional hospital pilot study, surgeons endorsed synchronous polypectomy for any polyp size and morphology (100%). Removal of proximal polyps within 5 cm was favoured (75%) given low perceived implantation risk (75%). All would remove polyps outside the planned resection segment. A quarter reported no outcome benefit (25%) by performing synchronous polypectomies. Conclusion – Mapping variation and drivers of synchronous polypectomy will inform consensus-building and guideline development, aiming to reduce unwarranted variation and repeat procedures without compromising oncologic safety.