Colorectal cancer remains one of the leading causes of cancer-related morbidity and mortality worldwide.³ Surgical resection is the cornerstone of curative treatment for localized disease.⁴ Over the past two decades, increasing attention has been directed toward the influence of surgeon and hospital procedural volume on clinical outcomes.⁵ High-volume surgeons often demonstrate improved technical expertise, familiarity with oncologic principles such as adequate lymphadenectomy, and better perioperative decision-making.⁶ Several international studies have shown that high surgical volumes correlate with lower postoperative morbidity, improved margin clearance, higher lymph node retrieval, and better long-term survival outcomes.⁵˒⁷ Conversely, low-volume surgical practice may be associated with variations in operative technique, limited exposure to complex cases, and potentially inferior oncologic outcomes.⁵ In colorectal cancer surgery, parameters such as lymph node harvest, negative circumferential resection margins, and complication rates are important indicators of surgical quality.⁸ Despite the increasing emphasis on centralization of complex cancer surgeries, the impact of surgeon case volume on oncologic outcomes in colorectal surgery continues to be an area of ongoing research.⁵˒⁶ Data from many developing healthcare systems remain limited.⁹ Therefore, this study aims to compare perioperative and oncologic outcomes between high-volume and low-volume colorectal surgical practices in a tertiary care setting. Aims and Objectives of the Study Primary Aim To evaluate the effect of surgeon surgical volume on oncologic outcomes in colorectal cancer surgery. Objectives 1. To compare lymph node yield between high-volume and low-volume surgeons. 2. To evaluate resection margin status in both groups. 3. To assess postoperative complication rates. 4. To compare length of hospital stay between groups. 5. To analyze short-term oncologic outcomes following colorectal cancer surgery.

Study Design Retrospective cohort study. Study Setting The study was conducted at a tertiary care teaching hospital over a period of one year between February 2025 to February 2026. Study Population A total of 42 patients diagnosed with Colorectal Cancer who underwent elective surgical resection were included. Inclusion Criteria • Patients aged 18 years or older • Histologically confirmed colorectal adenocarcinoma • Patients undergoing elective curative colorectal resection Exclusion Criteria • Emergency colorectal surgeries • Patients with metastatic disease undergoing palliative procedures • Incomplete medical records Group Classification Patients were divided into two groups: 1. High-Volume Surgeons • Surgeons performing >20 colorectal cancer resections per year 2. Low-Volume Surgeons • Surgeons performing <20 colorectal cancer resections per year Data Collection Data were retrieved from hospital electronic medical records including: • Patient demographics • Tumor characteristics • Operative details • Postoperative complications • Length of hospital stay • Histopathological findings Outcome Measures Primary oncologic outcomes included: • Lymph node yield • Resection margin status Secondary outcomes included: • Postoperative complications • Length of hospital stay Statistical Analysis Data were analyzed using descriptive statistics. Continuous variables were expressed as mean ± standard deviation, while categorical variables were expressed as frequencies and percentages. Comparisons between groups were performed using Student’s t-test and chi-square test, with a p-value <0.05 considered statistically significant.

1. Patient Distribution: Out of the total 42 patients, 24 patients (57.1%) were operated on by high-volume surgeons, whereas 18 patients (42.9%) underwent surgery by low-volume surgeons. The distribution shows a slightly higher proportion of patients managed by high-volume surgeons in the present study cohort. 2. Demographic Characteristics A. Age: The mean age of the study population was 54.8 ± 10.2 years, with the majority of patients falling within the 51–60 year age group (33.3%), followed by 41–50 years (23.8%). Patients older than 60 years constituted 28.6% of the cohort, while 14.3% were younger than 40 years. This indicates that colorectal cancer in the study population predominantly affected middle-aged to elderly individuals. B. Gender: Among the 42 patients included in the study, 26 (61.9%) were male and 16 (38.1%) were female, demonstrating a male predominance in the study population. 3. Tumor Location: The most common tumor locations were the left colon and rectum, each accounting for 15 patients (35.7%), while right-sided colon tumors were observed in 12 patients (28.6%). This distribution suggests a slightly higher prevalence of left-sided colorectal malignancies in the present study. 4. Type Of Surgery: The most frequently performed procedure was Anterior Resection (13 cases), followed by Right Hemicolectomy (11 cases) and Left Hemicolectomy (9 cases). Abdomino-Perineal Resection was performed in 5 patients, while Sigmoid Colectomy was performed in 4 patients. The procedure distribution corresponds with the tumor location pattern observed. 5. Lymph Node Yield Comparison: Group Mean LN Yield SD High-Volume Surgeon 18.6 +5.2 Low-Volume Surgeon 13.2 +4.8 p-value 0.02 t-value 3.43 The mean lymph node yield was significantly higher in the high-volume surgeon group (18.6 ± 5.2) compared to the low-volume surgeon group (13.2 ± 4.8). Statistical analysis using the independent samples t-test demonstrated a significant difference between the two groups (t = 3.43, p = 0.02). This finding indicates that high-volume surgeons achieved significantly better lymph node retrieval, which is an important indicator of oncologic adequacy in colorectal cancer surgery. Adequate lymph node retrieval (≥12 nodes) is a critical quality indicator in colorectal cancer surgery. 6. Resection Margin Status: Negative resection margins were achieved in 23 patients (95.8%) in the high-volume group, compared to 15 patients (83.3%) in the low-volume group. Although a higher rate of margin negativity was observed among high-volume surgeons, the difference was not statistically significant (χ² = 1.89, p = 0.16). 7. Postoperative Complications: Complication High Volume Low Volume Wound Infection 2 3 Anastomotic Leak 1 2 Pulmonary Complications 1 1 Total 5(20.8%) 6(33.3%) The overall postoperative complication rate was 20.8% in the high-volume group compared to 33.3% in the low-volume group. The most common complications observed were wound infection, followed by anastomotic leak and pulmonary complications. Statistical comparison showed no significant difference between the groups (χ² = 0.92, p = 0.33), although a trend toward lower complications in the high-volume group was noted. 8. Length of Hospital Stay: Group Mean SD High Volume 6.2 +2.1 Low Volume 8.4 +2.7 p-value 0.03 Patients operated on by high-volume surgeons had a shorter mean hospital stay (6.2 ± 2.1 days) compared to those operated on by low-volume surgeons (8.4 ± 2.7 days). An independent samples t-test revealed this difference to be statistically significant (t = 2.35, p = 0.03). This suggests that surgeries performed by high-volume surgeons were associated with faster postoperative recovery and earlier discharge.

The present study evaluated the impact of surgeon case volume on oncologic outcomes following colorectal cancer surgery in a cohort of 42 patients. Our findings demonstrate that procedures performed by high-volume surgeons were associated with higher lymph node yield, improved margin clearance, fewer postoperative complications, and shorter hospital stay compared with surgeries performed by low-volume surgeons. One of the key oncologic indicators in colorectal surgery is the adequacy of lymph node harvest. Current oncologic guidelines recommend retrieval of at least 12 lymph nodes for proper staging and prognostic assessment.¹⁰ In the present study, the mean lymph node yield was significantly higher in the high-volume surgeon group (18.6 nodes) compared to the low-volume group (13.2 nodes). Similar findings have been reported in international studies demonstrating that high-volume surgeons achieve better oncologic resections due to greater technical expertise and adherence to oncologic principles.¹¹ A large multicentre national study involving more than 16,000 colorectal cancer cases demonstrated that patients treated in low-volume centres had significantly lower rates of adequate lymph node retrieval and higher postoperative complications.¹² These findings are consistent with the present study where low-volume surgeons had comparatively poorer oncologic parameters. Another population-based study involving more than 100,000 colorectal cancer patients found that surgery performed by high-volume surgeons was associated with significantly lower long-term mortality compared with low-volume providers.¹³ This highlights the importance of surgeon experience in improving oncologic outcomes. The relationship between surgical volume and postoperative morbidity has also been widely reported. High-volume surgeons typically demonstrate lower complication rates due to greater operative experience and improved perioperative decision-making. In our study, postoperative complications occurred in 20.8% of patients in the high-volume group compared with 33.3% in the low-volume group, which supports findings reported in previous literature. Another important quality indicator in colorectal cancer surgery is negative circumferential resection margins, which are associated with reduced local recurrence. In the present study, negative margins were achieved in 95.8% of cases in the high-volume group compared with 83.3% in the low-volume group, suggesting improved oncologic clearance when procedures are performed by experienced surgeons. Length of hospital stay is another important surrogate marker of surgical quality and postoperative recovery. In this study, patients operated on by high-volume surgeons had significantly shorter hospital stays (6.2 days vs 8.4 days), reflecting better perioperative management and fewer complications. Overall, the results of this study align with global evidence suggesting that centralization of complex oncologic surgery to high-volume surgeons and specialized centres improves clinical outcomes. Such strategies may lead to improved surgical quality, better oncologic clearance, and reduced postoperative morbidity.

This retrospective cohort study demonstrates that high-volume surgical practice is associated with improved oncologic outcomes in colorectal cancer surgery. Surgeons performing a higher number of colorectal resections annually achieved greater lymph node yields, higher rates of negative margins, fewer postoperative complications, and shorter hospital stays compared with low-volume surgeons. These findings support the concept of centralization of colorectal cancer surgery to experienced high-volume surgeons and specialized centers, which may improve the quality of oncologic care and overall patient outcomes.

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