SP 3.13 Hospital and Surgeon Volume versus Outcomes after Colorectal Cancer Surgery: A Comprehensive Umbrella Review
Justin Ho, Essam Rama, Alessandro Martinino, Francesco GiovinazzoAbstract
Aims
An inverse relationship between surgical volume and outcomes has been suggested, with higher- volume hospitals and surgeons achieving better results, prompting debate over the centralisation of surgical services. However, minimum volume thresholds are unclear, and volume is a poor proxy for quality. This umbrella review synthesises the evidence on volume-outcome associations in colorectal surgery and assesses their clinical relevance to guide centralisation decisions.
Methods
We conducted an umbrella review (PRISMA 2020) to evaluate systematic reviews and meta-analyses on hospital/surgeon volume-outcome relationship in colorectal cancer. Cochrane Library, PubMed, EMBASE and MEDLINE were searched to 1 Oct 2025. Volume definitions and outcomes were extracted and meta-analysed by subgroup. AMSTAR2 and ROBIS were conducted for bias.
Results
Ten papers were included in our umbrella review. Hospital and surgeon volume were associated with lower post-operative mortality for all cancer types. Hospital volume was associated with improved overall survival for colorectal cancer, surgeon volume was associated with improved overall survival for all cancer types. There were no consistent significant differences in rates of the secondary outcomes (anastomotic leak rate, permanent stoma formation, local recurrence rate, APER rate). Heterogeneity was substantial for many analyses (I² >75%).
Conclusions
High-volume hospitals and surgeons significantly improve both short- and long-term outcomes for patients undergoing colorectal cancer surgery. However, a specific cut-off definition for high versus low-volume hospitals and surgeons is yet to be elucidated due to the heterogeneity of existing volume definitions. Future studies are required to confirm a threshold for this dose response relationship.