{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T18:53:19Z","timestamp":1782327199342,"version":"3.54.5"},"reference-count":23,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:00:00Z","timestamp":1782259200000},"content-version":"vor","delay-in-days":43,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>An inverse relationship between surgical volume and outcomes has been suggested, with higher-volume hospitals and surgeons achieving better results, prompting debate over the centralization of surgical services. However, minimum volume thresholds are unclear, and volume is a poor proxy for quality. Despite the significant global burden of colorectal cancer, the benefits of high-volume care remain uncertain. This umbrella review synthesized the evidence on volume\u2013outcome associations in colorectal surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>An umbrella review (PRISMA 2020) was conducted to evaluate systematic reviews and meta-analyses of the hospital\/surgeon volume\u2013outcome relationship in colorectal cancer. The Cochrane Library, PubMed, Embase, and MEDLINE were searched to 1 October 2025. Volume definitions and outcomes were extracted and meta-analysed by subgroup. A MeaSurement Tool to Assess Systematic Reviews 2 and Risk of Bias in Systematic Reviews were used for analysis of bias.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 150 unique records was identified, with 10 systematic reviews meeting the inclusion criteria. High- versus low-volume hospitals demonstrated an inverse relationship in terms of postoperative mortality following resection for rectal cancer (fixed- and random-effects models: odds ratio 0.73, 95 per cent confidence interval 0.64 to 0.82), colon cancer (fixed-effect model: odds ratio 0.74, 0.70 to 0.78; random-effects model: odds ratio 0.75, 0.69 to 0.81), and colorectal cancer (fixed- and random-effects models: odds ratio 0.77, 0.67 to 0.88). High- versus low-volume surgeons demonstrated an inverse relationship with respect to postoperative mortality following resection for rectal cancer (fixed- and random-effects models: odds ratio 0.69, 0.59 to 0.81), colon cancer (fixed-effect model: odds ratio 0.70, 0.63 to 0.77; random-effects model: odds ratio 0.68, 0.55 to 0.85), and colorectal cancer (fixed- and random-effects models: odds ratio 0.67, 0.60 to 0.74). There were no consistent significant differences in rates of the secondary outcomes (anastomotic leak rate, permanent stoma formation, local recurrence rate, rate of abdominoperineal excision of the rectum).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>High-volume hospitals and surgeons are associated with both improved 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 owing to the heterogeneity of existing volume definitions. Future studies are required to confirm a threshold for this dose\u2013response relationship.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/bjsopen\/zrag074","type":"journal-article","created":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T11:42:44Z","timestamp":1778067764000},"source":"Crossref","is-referenced-by-count":0,"title":["Hospital and surgeon volume\n                    <i>versus<\/i>\n                    outcomes after colorectal cancer surgery: umbrella review and meta-analysis"],"prefix":"10.1093","volume":"10","author":[{"given":"Justin","family":"Ho","sequence":"first","affiliation":[{"name":"Department of Surgery, University of Cambridge, Addenbrooke\u2019s Hospital , Cambridge ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Essam","family":"Rama","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hinchingbrooke Hospital , Huntingdon ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4016-534X","authenticated-orcid":false,"given":"Alessandro","family":"Martinino","sequence":"additional","affiliation":[{"name":"Department of Surgery, Duke University , Durham, North Carolina ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3392-9292","authenticated-orcid":false,"given":"Francesco","family":"Giovinazzo","sequence":"additional","affiliation":[{"name":"Department of Surgery, Ospedale San Camillo , Treviso ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,6,24]]},"reference":[{"key":"2026062414314075600_zrag074-B1","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.1016\/S0003-4975(02)04308-4","article-title":"The volume\u2013outcome relationship: from luft to leapfrog","volume":"75","author":"Shahian","year":"2003","journal-title":"Ann Thorac Surg"},{"key":"2026062414314075600_zrag074-B2","doi-asserted-by":"crossref","first-page":"1038","DOI":"10.1177\/000313480607201110","article-title":"The volume\u2013outcome debate revisited","volume":"72","author":"Finlayson Samuel","year":"2006","journal-title":"Am Surg"},{"key":"2026062414314075600_zrag074-B3","doi-asserted-by":"crossref","first-page":"826","DOI":"10.1007\/s00268-005-7987-6","article-title":"The case against volume as a measure of quality of surgical care","volume":"29","author":"Khuri","year":"2005","journal-title":"World J Surg"},{"key":"2026062414314075600_zrag074-B4","volume-title":"Colon Cancer","author":"Menon","year":"2025"},{"key":"2026062414314075600_zrag074-B5","first-page":"100082","article-title":"Transparency in the reporting of artificial intelligence\u2014the TITAN guideline","volume":"10","author":"Agha","year":"2025","journal-title":"Prem J Sci"},{"key":"2026062414314075600_zrag074-B6","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"2026062414314075600_zrag074-B7","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1186\/s13643-016-0384-4","article-title":"Rayyan\u2014a web and mobile app for systematic reviews","volume":"5","author":"Ouzzani","year":"2016","journal-title":"Syst Rev"},{"key":"2026062414314075600_zrag074-B8","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1016\/j.jclinepi.2015.06.005","article-title":"ROBIS: a new tool to assess risk of bias in systematic reviews was developed","volume":"69","author":"Whiting","year":"2016","journal-title":"J Clin Epidemiol"},{"key":"2026062414314075600_zrag074-B9","doi-asserted-by":"crossref","first-page":"j4008","DOI":"10.1136\/bmj.j4008","article-title":"AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both","volume":"358","author":"Shea","year":"2017","journal-title":"BMJ"},{"key":"2026062414314075600_zrag074-B10","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1136\/bmj.39343.408449.80","article-title":"Uncertainty in heterogeneity estimates in meta-analyses","volume":"335","author":"Ioannidis","year":"2007","journal-title":"BMJ"},{"key":"2026062414314075600_zrag074-B11","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1111\/j.1463-1318.2006.01100.x","article-title":"Influence of caseload and surgical speciality on outcome following surgery for colorectal cancer: a review of evidence. Part 1: short-term outcome","volume":"9","author":"Iversen","year":"2007","journal-title":"Colorectal Dis"},{"key":"2026062414314075600_zrag074-B12","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1111\/j.1463-1318.2006.01095.x","article-title":"Influence of caseload and surgical speciality on outcome following surgery for colorectal cancer: a review of evidence part 2: long-term outcome","volume":"9","author":"Iversen","year":"2007","journal-title":"Colorectal Dis"},{"key":"2026062414314075600_zrag074-B13","first-page":"192","article-title":"The effect of provider case volume on cancer mortality: systematic review and meta-analysis","volume":"59","author":"Gruen","year":"2009","journal-title":"CA Cancer J Clin"},{"key":"2026062414314075600_zrag074-B14","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1016\/j.surge.2010.07.003","article-title":"Impact of surgeon volume on outcomes of rectal cancer surgery: a systematic review and meta-analysis","volume":"8","author":"Archampong","year":"2010","journal-title":"Surgeon"},{"key":"2026062414314075600_zrag074-B15","doi-asserted-by":"crossref","first-page":"S55","DOI":"10.1016\/j.ejso.2010.06.027","article-title":"Volume and outcome in colorectal cancer surgery","volume":"36","author":"van Gijn","year":"2010","journal-title":"Eur J Surg Oncol"},{"key":"2026062414314075600_zrag074-B16","doi-asserted-by":"crossref","first-page":"S3","DOI":"10.1016\/j.ejso.2010.06.004","article-title":"The quality of cancer care initiative in the Netherlands","volume":"36","author":"Wouters","year":"2010","journal-title":"Eur J Surg Oncol"},{"issue":"3)","key":"2026062414314075600_zrag074-B17","article-title":"Workload and surgeon\u00b4s specialty for outcome after colorectal cancer surgery","author":"Archampong","year":"2012","journal-title":"Cochrane Database Syst Rev"},{"key":"2026062414314075600_zrag074-B18","doi-asserted-by":"crossref","first-page":"534","DOI":"10.21037\/jgo.2017.01.25","article-title":"Systematic review and a meta-analysis of hospital and surgeon volume\/outcome relationships in colorectal cancer surgery","volume":"8","author":"Huo","year":"2017","journal-title":"J Gastrointest Oncol"},{"key":"2026062414314075600_zrag074-B19","doi-asserted-by":"crossref","first-page":"9634","DOI":"10.1097\/JS9.0000000000003168","article-title":"Hospital volume matters: a meta-analysis of mortality after colorectal cancer surgery","volume":"111","author":"Guo","year":"2025","journal-title":"Int J Surg"},{"key":"2026062414314075600_zrag074-B20","doi-asserted-by":"crossref","first-page":"1320","DOI":"10.1097\/DCR.0000000000001198","article-title":"Association between hospital and surgeon volume and rectal cancer surgery outcomes in patients with rectal cancer treated since 2000: systematic literature review and meta-analysis","volume":"61","author":"Chioreso","year":"2018","journal-title":"Dis Colon Rectum"},{"key":"2026062414314075600_zrag074-B21","volume-title":"Colorectal Cancer (NG151)","author":"National Institute for Health and Care Excellence"},{"key":"2026062414314075600_zrag074-B22","doi-asserted-by":"crossref","first-page":"e098569","DOI":"10.1136\/bmjopen-2024-098569","article-title":"More is more? The role of surgeon in the volume\u2013outcome relationship: an Italian population-based cohort study","volume":"15","author":"Soldati","year":"2025","journal-title":"BMJ Open"},{"key":"2026062414314075600_zrag074-B23","doi-asserted-by":"crossref","first-page":"2821","DOI":"10.1016\/j.ejso.2021.05.045","article-title":"Textbook outcome after rectal cancer surgery as a composite measure for quality of care: a population-based study","volume":"47","author":"Warps","year":"2021","journal-title":"Eur J Surg Oncol"}],"container-title":["BJS Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/bjsopen\/article-pdf\/10\/3\/zrag074\/68607510\/zrag074.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/bjsopen\/article-pdf\/10\/3\/zrag074\/68607510\/zrag074.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T18:31:49Z","timestamp":1782325909000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/bjsopen\/article\/doi\/10.1093\/bjsopen\/zrag074\/8715731"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,12]]},"references-count":23,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,5,12]]}},"URL":"https:\/\/doi.org\/10.1093\/bjsopen\/zrag074","relation":{},"ISSN":["2474-9842"],"issn-type":[{"value":"2474-9842","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,6]]},"published":{"date-parts":[[2026,5,12]]},"article-number":"zrag074"}}