{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T11:14:43Z","timestamp":1788347683174,"version":"build-2803163510"},"reference-count":21,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T00:00:00Z","timestamp":1780963200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T00:00:00Z","timestamp":1780963200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100017744","name":"Japan Surgical Society","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100017744","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Annals of Gastroent Surgery"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Regional disparities in surgical resources may influence the delivery and sustainability of gastroenterological surgery, particularly in countries experiencing rapid population aging and depopulation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This nationwide cross\u2010sectional study used data from the Japanese National Clinical Database to examine temporal trends (2013\u20132023) 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 955\u2009168 colectomies, 514\u2009155 gastrectomies, and 126\u2009008 pancreaticoduodenectomies were analyzed. Colectomy volume increased despite declining surgeon numbers in medium\u2010 and high\u2010density 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 \u2265\u200920\u2009years of experience were disproportionately represented in low\u2010density areas.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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\u2010density areas depends heavily on senior surgeons, raising concerns regarding generational transition and long\u2010term sustainability of gastroenterological surgical services in Japan.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ags3.70239","type":"journal-article","created":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T01:20:32Z","timestamp":1781054432000},"page":"1646-1654","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Regional Disparities in Case Volumes and Surgeon Distribution in Gastroenterological Surgery"],"prefix":"10.1002","volume":"10","author":[{"given":"Hiroshi","family":"Hasegawa","sequence":"first","affiliation":[{"name":"Japan Surgical Society Committee for Improvement of Surgeons' Work Environment  Tokyo Japan"},{"name":"Division of Gastrointestinal Surgery, Department of Surgery Kobe University Graduate School of Medicine  Kobe Hyogo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiraku","family":"Kumamaru","sequence":"additional","affiliation":[{"name":"Department of Healthcare Quality Assessment The University of Tokyo  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Momoko","family":"Ara","sequence":"additional","affiliation":[{"name":"Japan Surgical Society Committee for Improvement of Surgeons' Work Environment  Tokyo Japan"},{"name":"Department of Gastroenterological Surgery I Hokkaido University Graduate School of Medicine  Sapporo Hokkaido Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshihiro","family":"Kakeji","sequence":"additional","affiliation":[{"name":"Japan Surgical Society Committee for Improvement of Surgeons' Work Environment  Tokyo Japan"},{"name":"Division of Gastrointestinal Surgery, Department of Surgery Kobe University Graduate School of Medicine  Kobe Hyogo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideko","family":"Yamauchi","sequence":"additional","affiliation":[{"name":"Japan Surgical Society Committee for Improvement of Surgeons' Work Environment  Tokyo Japan"},{"name":"Department of Surgery University of Hawaii John A. Burns School of Medicine  Honolulu Hawaii USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masafumi","family":"Inomata","sequence":"additional","affiliation":[{"name":"Japan Surgical Society Committee for Improvement of Surgeons' Work Environment  Tokyo Japan"},{"name":"Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine Oita University  Yufu Oita Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sadako","family":"Akashi\u2010Tanaka","sequence":"additional","affiliation":[{"name":"Japan Surgical Society Committee for Improvement of Surgeons' Work Environment  Tokyo Japan"},{"name":"Department of Breast Surgery, Faculty of Medicine Tokyo Women's Medical University  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koji","family":"Ito","sequence":"additional","affiliation":[{"name":"Japan Surgical Society Committee for Improvement of Surgeons' Work Environment  Tokyo Japan"},{"name":"Department of Surgery Tsuchiura Kyodo Hospital  Ibaraki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0382-2520","authenticated-orcid":false,"given":"Shinji","family":"Itoh","sequence":"additional","affiliation":[{"name":"Japan Surgical Society Committee for Improvement of Surgeons' Work Environment  Tokyo Japan"},{"name":"Department of Surgery and Science, Graduate School of Medical Sciences Kyushu University  Fukuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2318-1129","authenticated-orcid":false,"given":"Hidetoshi","family":"Eguchi","sequence":"additional","affiliation":[{"name":"Japan Surgical Society Committee for Improvement of Surgeons' Work Environment  Tokyo Japan"},{"name":"Department of Gastroenterological Surgery Osaka University  Suita Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8756-1315","authenticated-orcid":false,"given":"Kazumi","family":"Kawase","sequence":"additional","affiliation":[{"name":"Japan Surgical Society Committee for Improvement of Surgeons' Work Environment  Tokyo Japan"},{"name":"Department of Surgery The Jikei University School of Medicine Katsushika Medical Center  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-0508-3260","authenticated-orcid":false,"given":"Yoshiaki","family":"Kinoshita","sequence":"additional","affiliation":[{"name":"Japan Surgical Society Committee for Improvement of Surgeons' Work Environment  Tokyo Japan"},{"name":"Department of Pediatric Surgery Niigata University  Niigata Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuki","family":"Kiyozumi","sequence":"additional","affiliation":[{"name":"Japan Surgical Society Committee for Improvement of Surgeons' Work Environment  Tokyo Japan"},{"name":"Department of Surgery Saiseikai Kumamoto Hospital  Kumamoto Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shogo","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"Japan Surgical Society Committee for Improvement of Surgeons' Work Environment  Tokyo Japan"},{"name":"Department of Gastroenterological Surgery Osaka International Cancer Institute  Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ikuko","family":"Shibasaki","sequence":"additional","affiliation":[{"name":"Japan Surgical Society Committee for Improvement of Surgeons' Work Environment  Tokyo Japan"},{"name":"Department of Cardiovascular Surgery Iwaki City Medical Center  Fukushima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiyoe","family":"Shirota","sequence":"additional","affiliation":[{"name":"Japan Surgical Society Committee for Improvement of Surgeons' Work Environment  Tokyo Japan"},{"name":"Department of Pediatric Surgery Nagoya University Graduate School of Medicine  Nagoya Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroyuki","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Japan Surgical Society Committee for Improvement of Surgeons' Work Environment  Tokyo Japan"},{"name":"Department of Chest Surgery Fukushima Medical University  Fukushima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chie","family":"Takasu","sequence":"additional","affiliation":[{"name":"Japan Surgical Society Committee for Improvement of Surgeons' Work Environment  Tokyo Japan"},{"name":"Department of Surgery Tokushima University  Tokushima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aoi","family":"Fujikawa","sequence":"additional","affiliation":[{"name":"Japan Surgical Society Committee for Improvement of Surgeons' Work Environment  Tokyo Japan"},{"name":"Kurume University  Kurume Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saki","family":"Bessho","sequence":"additional","affiliation":[{"name":"Japan Surgical Society Committee for Improvement of Surgeons' Work Environment  Tokyo Japan"},{"name":"Department of Cardiovascular Surgery Ise Red Cross Hospital  Ise Mie Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8723-1906","authenticated-orcid":false,"given":"Kiyomi","family":"Horiuchi","sequence":"additional","affiliation":[{"name":"Japan Surgical Society Committee for Improvement of Surgeons' Work Environment  Tokyo Japan"},{"name":"Department of Endocrine Surgery Tokyo Women's Medical University  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kosei","family":"Maemura","sequence":"additional","affiliation":[{"name":"Japan Surgical Society Committee for Improvement of Surgeons' Work Environment  Tokyo Japan"},{"name":"Department of Gastroenterological Surgery Kagoshima City Hospital  Kagoshima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayako","family":"Maruo","sequence":"additional","affiliation":[{"name":"Japan Surgical Society Committee for Improvement of Surgeons' Work Environment  Tokyo Japan"},{"name":"Public Health Department Hyogo Prefectural Government  Kobe Hyogo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0238-2845","authenticated-orcid":false,"given":"Takuya","family":"Miura","sequence":"additional","affiliation":[{"name":"Japan Surgical Society Committee for Improvement of Surgeons' Work Environment  Tokyo Japan"},{"name":"Department of Gastroenterological Surgery and Pediatric Surgery Hirosaki University Graduate School of Medicine  Hirosaki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3948-5044","authenticated-orcid":false,"given":"Yuji","family":"Miyamoto","sequence":"additional","affiliation":[{"name":"Japan Surgical Society Committee for Improvement of Surgeons' Work Environment  Tokyo Japan"},{"name":"Department of Gastroenterological Surgery, Graduate School of Medical Sciences Kumamoto University  Kumamoto Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshiki","family":"Yajima","sequence":"additional","affiliation":[{"name":"Japan Surgical Society Committee for Improvement of Surgeons' Work Environment  Tokyo Japan"},{"name":"Department of General Thoracic Surgery, Faculty of Medicine Kagawa University  Miki Kagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayuko","family":"Yasuda","sequence":"additional","affiliation":[{"name":"Japan Surgical Society Committee for Improvement of Surgeons' Work Environment  Tokyo Japan"},{"name":"Department of Thoracic Surgery NHO Nagoya Medical Center  Nagoya Aichi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshiharu","family":"Yamaguchi","sequence":"additional","affiliation":[{"name":"Japan Surgical Society Committee for Improvement of Surgeons' Work Environment  Tokyo Japan"},{"name":"Department of Gastroenterological Surgery Cancer Institute Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tadashi","family":"Iwanaka","sequence":"additional","affiliation":[{"name":"Japan Surgical Society  Tokyo Japan"},{"name":"Saitama Prefectural Hospital Organization  Saitama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideo","family":"Baba","sequence":"additional","affiliation":[{"name":"Japan Surgical Society Committee for Improvement of Surgeons' Work Environment  Tokyo Japan"},{"name":"The Chemo\u2010Sero\u2010Therapeutic Research Institute  Kumamoto Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akinobu","family":"Taketomi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery I Hokkaido University Graduate School of Medicine  Sapporo Hokkaido Japan"},{"name":"Japan Surgical Society  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,9]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.puhe.2015.04.001"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1177\/00031348251323712"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcpo.2025.100662"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/XCS.0000000000001601"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(25)01330-3"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)00516-4"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00595-025-03082-2"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/jrh.12658"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1787\/5jz5sq5ls1wl\u2010en"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)60160-X"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00595-024-02980-1"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/ags3.12868"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/ags3.12419"},{"key":"e_1_2_11_15_1","unstructured":"Statistics Bureau of Japan e\u2010Stat: Portal Site of Official Statistics of Japanaccessed at February 11 2026 https:\/\/www.e\u2010stat.go.jp\/."},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/ags3.12865"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/ags3.12813"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00595-024-02864-4"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-023-06820-0"},{"key":"e_1_2_11_20_1","unstructured":"START\u2010POINT Map painting generator for Japanaccessed at February 10 2026 https:\/\/www.start\u2010point.net\/maps\/map_maker\/."},{"key":"e_1_2_11_21_1","unstructured":"National Cancer Center Japan Cancer Statistics by Site Cancer Registry and Statistics Cancer Information Service National Cancer Center Japanaccessed at February 11 2026 https:\/\/ganjoho.jp\/reg_stat\/statistics\/stat\/cancer\/index.html."},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.1250542"}],"container-title":["Annals of Gastroenterological Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ags3.70239","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ags3.70239","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ags3.70239","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T10:29:39Z","timestamp":1788344979000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ags3.70239"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,9]]},"references-count":21,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1002\/ags3.70239"],"URL":"https:\/\/doi.org\/10.1002\/ags3.70239","archive":["Portico"],"relation":{},"ISSN":["2475-0328","2475-0328"],"issn-type":[{"value":"2475-0328","type":"print"},{"value":"2475-0328","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,9]]},"assertion":[{"value":"2026-03-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-25","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-09","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}