Regional Disparities in Case Volumes and Surgeon Distribution in Gastroenterological Surgery

Regional disparities in surgical resources may influence the delivery and sustainability of gastroenterological surgery, particularly in countries experiencing rapid population aging and depopulation.

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.

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.

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.