Abstract
AIM: Specialization with subsequent evolving minimally invasive surgery (MIS) has been increasingly adopted in colorectal cancer care. This study aims to evaluate the impact of centralization and team specialization on oncologic quality and patient safety in colorectal cancer over 15 years by comparing an early phase with a later (post-specialization) phases; and to describe trends in MIS adoption over unit’s progression period with the framework of MIS adoption. METHODS: A retrospective cohort study that included all elective oncologic colorectal resections at a tertiary referral center for the past 15 years. Data was analyzed in five cohorts with timeline intervals consisting of three years duration from 2010 to 2024. Outcomes included MIS utilization, conversions, R0 resection, lymph node adequacy (≥ 12), major complications (Clavien–Dindo ≥ III), reoperation for leak, and length of stay (LOS). RESULTS: Among 1,142 colorectal cancer resections, MIS adoption rose from 51.2% in 2012 to 93.6% in 2024. Robotic surgery, introduced in 2017, accounted for 31% of cases by 2022–2024. Oncologic quality improved significantly (R0 resection 87.6% to 96.0%, ≥ 12 nodes 88.8% to 96.9%; both p < 0.001). Major complications decreased from 12.3% to 8.8% and reoperation for leak from 4.3% to 2.1%. Mean LOS was 6.4 days for MIS vs. 8.4 days for open (p < 0.001), reducing to 5.5 days for MIS in 2024. CONCLUSION: A phased centralization and specialization in colorectal unit enabled safe and effective adoption of laparoscopic and robotic surgery. In addition to increased proportion of colorectal resection being done using MIS technique, improved clinical and oncological outcomes were seen during the study period and unite development. MIS consistently shortened hospital stay without compromising safety, affirming its role as the standard in specialized care.