Cancer Treatment Systems: Highly Complex Surgeries Should Be Consolidated

Editorial

17:44 JST, May 20, 2026

The shortage of surgeons is becoming increasingly severe, making it difficult to maintain a system in which everyone can receive advanced cancer surgery at a local hospital. Cancer treatment systems should be reviewed according to regional circumstances.

The Health, Labor and Welfare Ministry will accelerate its initiative to have certain hospitals perform cancer surgeries. The ministry plans to include role-sharing among hospitals as a criteria for receiving a surcharge payment under the medical fee schedule, which is due to be revised next month.

For example, highly complex surgeries, such as the removal of esophageal or pancreatic cancer, will be performed at core hospitals, such as university hospitals, and specialized physicians will be assigned to those hospitals. On the other hand, surgeries considered standard, such as those for lung or breast cancer, are expected to be handled by midsize hospitals.

The government had aimed to establish a system in which patients can receive appropriate cancer treatment regardless of where they live. However, consolidation is unavoidable given the current state of the health care system.

The total number of doctors currently exceeds 340,000, up more than 10% over the past decade, but the number of gastroenterological surgeons — the doctors who tend to perform the most cancer surgeries — has decreased by 10%. This is because the demanding nature of their work, including handling emergency surgeries, has accelerated a trend among young doctors to shy away from becoming such specialists.

Under these circumstances, it would be impossible to maintain an adequate system if specialized personnel were dispersed across various hospitals.

The consolidation of advanced surgeries is desirable for patient safety as well. This is because the more surgeries a surgeon performs, the more their skills improve and the higher the quality of care tends to be.

Last summer, the ministry urged prefectural governments to proceed with concrete discussions toward the consolidation of cancer treatment. However, 28 prefectures currently have not even set a date for these discussions.

Highly complex surgeries command high medical fees, which serve as a vital revenue source for hospitals. Consequently, hospitals’ reluctance to relinquish these surgeries appears to be a reason why the discussions are proving difficult.

As the population declines, the demand for cancer surgery will decrease. It is not wise for hospitals to compete with one another for patients. It is desirable for hospitals to discuss how to divide roles among themselves for the viability of regional health care.

It is important for regional health care stakeholders to discuss data-driven collaboration mechanisms, such as designating hospitals that perform a high volume of surgeries to perform advanced surgical procedures, while others take on postoperative chemotherapy treatments, based on each hospital’s track record.

Okinawa Prefecture was quick to implement consolidation, designating specific hospitals as treatment hubs based on cancer type. Such examples can be used as a guideline.

Measures should be considered for patients who can no longer undergo surgery at a local hospital, such as having municipalities cover their transportation cost to and from the hospital.

(From The Yomiuri Shimbun, May 20, 2026)