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The surgeon's skill: Surgical technique is undoubtedly very important. Accurate identification of planes and employing correct techniques e.g. total mesorectal excision and cylindrical resections in early cases and enbloc resections in more advanced cases. Training plays an important part in developing these skills.
Surgical philosophy: Radical aggressive surgeons, when faced with more locally advanced disease tend to favour radical enbloc multivisceral resection, with its inherent higher risks of complications and increased mortality. They attempt to cure more patients or improve the quality and duration of patients' life, while doing more lengthy, more stressful operations. Conservative surgeons in the same situations would opt for bypass or a diverting stoma, avoiding the potential for postoperative complications & mortality, but denying the patient the benefits of tumour removal with consequent
The number of patients treated by a surgeon in a year: Many studies have shown that surgeons who operate on more patients (at least 20 per year) tend to produce better results.
Case mix: The proportion of patients with advanced disease, proportion of patients presenting as an emergency, proportion of elderly patients and proportion of patients with serious co-morbidity, all influence results of individual surgeons.
Quality of pathological reporting: Quality reporting is vital, as limited sampling of nodes or inadequate examination of the circumferential margins would downstage tumours or would classify it as curative and lead to inaccuracy in interpretation of results.
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