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Background: A volume-outcome relationship has been described for numerous medical and surgical conditions. The purpose of this study was to determine whether morbidity and mortality in patients undergoing elective resection of colon cancer are associated with surgeon or hospital volume. Methods: Using the U.S. Nationwide Inpatient Sample database, we identified all adult patients who underwent elective resection for colon cancer as their primary procedure between 2003 and 2007. Cases were divided into three groups according to the average number of resections performed annually by each surgeon: low-volume (≤4/year), intermediate volume (5-9/year), or high-volume (≥ 10/year). Annual hospital case-load was also categorized as low-volume (≤ 30/year), intermediate-volume (31-60/year) and high-volume (≥61/year). Multiple logistic regression models were used to identify differences in morbidity and mortality according to hospital and surgeon volume while controlling for patient and tumor-related factors, including comorbidities according to the. Elixhauser algorithm.Results: A total of 54,000 patients underwent resection of colon cancer by 7313 surgeons in 1398 hospitals. In univariate analysis, a reduction in mortality rate was observed among patients operated on by high-volume surgeons (2.6 vs 3.9%; p<0.0001) or in high-volume hospitals (2.6 vs 3.6%; p < 0.0001) compared to the corresponding low-volume groups. After adjusting for important covariates including hospital volume, colon cancer resection by high-volume surgeons was an independent predictor of decreased morbidity (odds ratio [OR]: 0.91; 95% CI 0.85-0.97) and mortality (OR: 0.75; 95% CI 0.65-0.86). Mortality was lowest among patients operated on by high-volume surgeons in high-volume hospitals (2.2% vs 3.9%; OR 0.56; 95% CI 0.46-0.68). Resection by high-volume surgeons was also associated with a decreased length of stay and reduced hospital charges.Conclusions:In patients undergoing elective resection of colon cancer, procedures done by high-volume surgeons are associated with decreased morbidity and mortality.