Achieving textbook outcomes during rectal cancer surgery correlates with better long-term survival more than hospital volume does.

• Only 28.5% of patients reached textbook outcomes (TO).
• Patients at high-volume hospitals had a higher TO rate (31.2%) compared to medium (29.6%) and low-volume (23.2%) hospitals.

Prioritizing TO criteria can enhance survival rates regardless of hospital case volume.

• A 40% reduction in long-term mortality was observed for patients achieving TO, emphasizing quality over quantity in surgical care.