{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T01:10:59Z","timestamp":1773277859931,"version":"3.50.1"},"reference-count":31,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T00:00:00Z","timestamp":1773187200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Introduction: Guam, the largest U.S. territory in Micronesia, plays a central role in surgical care for the local indigenous community and surrounding Pacific Island nations, yet remains underrepresented in surgical systems research. Methods: We conducted a mixed-methods study. Quantitative data were collected on operating volume, personnel, infrastructure, and surgical services at Guam Memorial Hospital (GMH) and Guam Regional Medical City (GRMC). Semi-structured interviews with hospital leadership and surgical providers captured qualitative insights on strengths, challenges, and future plans. Results: GMH and GRMC collectively provide general emergency, obstetric, and basic pediatric surgery, although advanced subspecialty and oncologic care remain limited. Although surgeons are highly adaptable with broad-practice capability, challenges, including resource limitations, aging facilities, advanced presentation, and subspecialty recruitment, limit the cases that are operable on Guam, resulting in expensive medical transfer. Anticipated stressors such as oncologic and non-communicable disease burden may further strain the system, emphasizing the necessity for modernized facilities and targeted recruitment of surgeons with regional ties. Conclusion: Strengthening Guam\u2019s surgical capacity is essential for the provision of oncologic care and the advancement of health equity across the Pacific region, emphasizing an urgent need for investment in infrastructure, locally relevant workforce training, and regional policy development.<\/jats:p>","DOI":"10.3390\/ijerph23030353","type":"journal-article","created":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T10:43:27Z","timestamp":1773225807000},"page":"353","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Assessing Surgical Capacity in Guam: Current Strengths and Future Goals"],"prefix":"10.3390","volume":"23","author":[{"given":"Ryan V.","family":"Benavente","sequence":"first","affiliation":[{"name":"Harvard Medical School, Harvard University, Boston, MA 02115, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"Jr.","given":"Eduardo B.","family":"Biala","sequence":"additional","affiliation":[{"name":"John A. Burns School of Medicine, University of Hawaii, Honolulu, HI 96813, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brandon A.","family":"Lopez","sequence":"additional","affiliation":[{"name":"University of Texas Medical Branch, The University of Texas System, Galveston, TX 77550, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Megan Y.","family":"Gimmen","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Harvard University, Boston, MA 02115, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3572-7379","authenticated-orcid":false,"given":"Eric T.","family":"Pineda","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Elson. S. Floyd College of Medicine, Washington State University, Spokane, WA 99202, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4808-6697","authenticated-orcid":false,"given":"John Reinier F.","family":"Narvaez","sequence":"additional","affiliation":[{"name":"Department of Surgery, Guam Regional Medical City, Dededo, GU 96913, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Russell K.","family":"Woo","sequence":"additional","affiliation":[{"name":"Department of Surgery, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI 96813, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neal A.","family":"Palafox","sequence":"additional","affiliation":[{"name":"Department of Family Medicine and Community Health, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI 96813, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8939-7646","authenticated-orcid":false,"given":"Lee E.","family":"Buenconsejo-Lum","sequence":"additional","affiliation":[{"name":"Department of Family Medicine and Community Health, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI 96813, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,11]]},"reference":[{"key":"ref_1","first-page":"100830","article-title":"Assessment of essential surgical and anaesthesia care capacity: A cross-sectional study in five Pacific Island Countries","volume":"39","author":"Qin","year":"2023","journal-title":"Lancet Reg. Health-West. 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