Purpose As survival following colorectal cancer (CRC) surgery improves, long-term health-related quality of life (HRQoL) has emerged as a critical outcome of surgical care. However, survivorship data from regional Australia remain limited despite known disparities in access to multidisciplinary services. This study evaluated HRQoL after CRC surgery in a regional population and identified clinical and psychosocial determinants of poor outcomes, with a focus on modifiable targets for collaborative survivorship care. Methodology A cross-sectional study was conducted of patients who underwent CRC resection at a regional Australian hospital between 2015 and 2022. Participants completed validated patient-reported outcome measures assessing HRQoL, anxiety, depression, fear of cancer recurrence, social support, optimism, health literacy, and spiritual wellbeing. Demographic, disease, and operative data were collected via retrospective chart review. HRQoL scores were compared with Australian population norms, and associations with explanatory variables were analysed. Results Forty-seven patients participated. Compared with population norms, patients reported significantly worse HRQoL across multiple functional and symptom domains. Clinically significant anxiety and fear of cancer recurrence were common. Psychosocial factors demonstrated the strongest and most consistent associations with HRQoL, exceeding the influence of surgical approach, complications, tumour stage, or time since surgery. Conclusion Long-term HRQoL following CRC surgery in regional Australia is predominantly shaped by psychosocial distress rather than operative factors alone. These findings highlight a critical gap in current surgical care and support the integration of routine psychosocial screening and multidisciplinary, collaborative survivorship pathways within colorectal surgical services to improve outcomes for regional patients.