Surgeons should note that higher surgical volume correlates with better outcomes in total mesorectal excision (TME) for rectal cancer.

• Facilities performing 16 or more TME annually were more likely to report TME grades (p=0.02).
• Robotic-assisted surgery achieved the highest complete TME rates (p<0.001) and lower conversion rates compared to laparoscopy (4.6% vs 14.6%, p<0.001).

Complete TME significantly improved lymph node yield (p=0.001), reduced residual tumor (p<0.001), and ensured negative margins (p<0.001).

Consider prioritizing higher-volume centers and robotic techniques to enhance patient outcomes.