Regional Disparities in Case Volumes and Surgeon Distribution in Gastroenterological Surgery

ABSTRACT Background Regional disparities in surgical resources may influence the delivery and sustainability of gastroenterological surgery, particularly in countries experiencing rapid population aging and depopulation. Methods This nationwide cross‐sectional study used data from the Japanese National Clinical Database to examine temporal trends (2013–2023) in surgical volume, surgeon supply, and annual operative volume per surgeon for colectomy, gastrectomy, and pancreaticoduodenectomy. Analyses were conducted at the prefectural level and stratified by population density and surgeon experience. Results A total of 955 168 colectomies, 514 155 gastrectomies, and 126 008 pancreaticoduodenectomies were analyzed. Colectomy volume increased despite declining surgeon numbers in medium‐ and high‐density areas, resulting in increased operative volume per surgeon. Gastrectomy volume decreased nationwide, whereas pancreaticoduodenectomy volume increased across all regions, accompanied by a reduction in surgeon supply and a rise in procedures per surgeon. By 2023, operative volume per surgeon was largely comparable across population density categories. Notably, surgeons with ≥ 20 years of experience were disproportionately represented in low‐density areas. Conclusions Although regional differences in population density persist, surgeon workload for major gastroenterological procedures has converged across regions in recent years. However, surgical care in low‐density areas depends heavily on senior surgeons, raising concerns regarding generational transition and long‐term sustainability of gastroenterological surgical services in Japan.

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Publication Details

Journal
Annals of Gastroenterological Surgery
Published
2026-06-09
DOI
https://doi.org/10.1002/ags3.70239
Primary Topic
Surgical Simulation and Training
Type
article
Field-Weighted Citation Impact
0.00

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article

Regional Disparities in Case Volumes and Surgeon Distribution in Gastroenterological Surgery

Tadashi Iwanaka, Yoshihiro Kakeji, 矢島俊樹, Kiyomi Horiuchi et al.
Annals of Gastroenterological Surgery
Surgical Simulation and Training
article

Regional Disparities in Case Volumes and Surgeon Distribution in Gastroenterological Surgery

Tadashi Iwanaka, Yoshihiro Kakeji, 矢島俊樹, Kiyomi Horiuchi, Kosei Maemura, Yuji Miyamoto, Hiraku Kumamaru, Chiyoe Shirota, Ikuko Shibasaki, Yuki Kiyozumi, Toshiharu Yamaguchi, Kazumi Kawase, Momoko Ara, Hideko Yamauchi, Yoshiaki Kinoshita, Sadako Akashi‐Tanaka, Takuya Miura, Hiroyuki Suzuki, Koji Ito, Ayuko Yasuda, Hideo Baba, Shinji Itoh, Shogo Kobayashi, Aoi Fujikawa, Ayako Maruo, Hidetoshi Eguchi, Chie Takasu, Akinobu Taketomi, Saki Bessho, Masafumi Inomata, Hiroshi Hasegawa
article en

Abstract

ABSTRACT Background Regional disparities in surgical resources may influence the delivery and sustainability of gastroenterological surgery, particularly in countries experiencing rapid population aging and depopulation. Methods This nationwide cross‐sectional study used data from the Japanese National Clinical Database to examine temporal trends (2013–2023) in surgical volume, surgeon supply, and annual operative volume per surgeon for colectomy, gastrectomy, and pancreaticoduodenectomy. Analyses were conducted at the prefectural level and stratified by population density and surgeon experience. Results A total of 955 168 colectomies, 514 155 gastrectomies, and 126 008 pancreaticoduodenectomies were analyzed. Colectomy volume increased despite declining surgeon numbers in medium‐ and high‐density areas, resulting in increased operative volume per surgeon. Gastrectomy volume decreased nationwide, whereas pancreaticoduodenectomy volume increased across all regions, accompanied by a reduction in surgeon supply and a rise in procedures per surgeon. By 2023, operative volume per surgeon was largely comparable across population density categories. Notably, surgeons with ≥ 20 years of experience were disproportionately represented in low‐density areas. Conclusions Although regional differences in population density persist, surgeon workload for major gastroenterological procedures has converged across regions in recent years. However, surgical care in low‐density areas depends heavily on senior surgeons, raising concerns regarding generational transition and long‐term sustainability of gastroenterological surgical services in Japan.

Annals of Gastroenterological Surgery
Kurume University (JP), Osaka Gakuin University (JP), University of Hawaiʻi at Mānoa (US), Imperial Household Agency (JP), Fukushima Medical University (JP), Kyushu University (JP), Hirosaki University (JP), Saitama Prefectural University (JP), Oita University (JP), Kagawa University (JP), Hokkaido University (JP), Saitama Prefecture (JP), Society of Thoracic Surgeons (US), Tokyo Health Care University (JP), Tsuchiura Kyodo General Hospital (JP), Niigata University of Rehabilitation (JP), Saiseikai Kumamoto Hospital (JP), Katsushika Medical Center (JP), Kagoshima City Hospital (JP), Kaketsuken (Japan) (JP), Japan Surgical Society (JP), Saitama Municipal Hospital (JP), Tokyo Women's Medical University (JP), The Cancer Institute Hospital (JP), Osaka International Cancer Institute (JP), Ise Red Cross Hospital (JP), Nagoya Medical Center (JP), Hyogo Prefectural Institute of Environmental Sciences (JP), Nagoya University (JP), Kobe University (JP), Niigata University (JP), Tokushima University (JP), Kumamoto University (JP), The University of Osaka (JP)
Japan Surgical Society
Industry, innovation and infrastructure
Openalex Percentile: Top 6%
Surgical Simulation and Training
DOIOpen Access PDFOpenAlex
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