PT - JOURNAL ARTICLE AU - Lei Huang AU - Lina Jansen AU - Yesilda Balavarca AU - Esther Molina-Montes AU - Masoud Babaei AU - Lydia van der Geest AU - Valery Lemmens AU - Liesbet Van Eycken AU - Harlinde De Schutter AU - Tom B Johannesen AU - Claus W Fristrup AU - Michael B Mortensen AU - Maja Primic-Žakelj AU - Vesna Zadnik AU - Nikolaus Becker AU - Thilo Hackert AU - Margit Mägi AU - Tiziana Cassetti AU - Romano Sassatelli AU - Robert Grützmann AU - Susanne Merkel AU - Ana F Gonçalves AU - Maria J Bento AU - Péter Hegyi AU - Gábor Lakatos AU - Andrea Szentesi AU - Michel Moreau AU - Tony van de Velde AU - Annegien Broeks AU - Milena Sant AU - Pamela Minicozzi AU - Vincenzo Mazzaferro AU - Francisco X Real AU - Alfredo Carrato AU - Xavier Molero AU - Marc G Besselink AU - Núria Malats AU - Markus W Büchler AU - Petra Schrotz-King AU - Hermann Brenner TI - Resection of pancreatic cancer in Europe and USA: an international large-scale study highlighting large variations AID - 10.1136/gutjnl-2017-314828 DP - 2019 Jan 01 TA - Gut PG - 130--139 VI - 68 IP - 1 4099 - http://gut.bmj.com/content/68/1/130.short 4100 - http://gut.bmj.com/content/68/1/130.full SO - Gut2019 Jan 01; 68 AB - Objective Resection can potentially cure resectable pancreatic cancer (PaC) and significantly prolong survival in some patients. This large-scale international study aimed to investigate variations in resection for PaC in Europe and USA and determinants for its utilisation.Design Data from six European population-based cancer registries and the US Surveillance, Epidemiology, and End Results Program database during 2003–2016 were analysed. Age-standardised resection rates for overall and stage I–II PaCs were computed. Associations between resection and demographic and clinical parameters were assessed using multivariable logistic regression models.Results A total of 153 698 records were analysed. In population-based registries in 2012–2014, resection rates ranged from 13.2% (Estonia) to 21.2% (Slovenia) overall and from 34.8% (Norway) to 68.7% (Denmark) for stage I–II tumours, with great international variations. During 2003–2014, resection rates only increased in USA, the Netherlands and Denmark. Resection was significantly less frequently performed with more advanced tumour stage (ORs for stage III and IV versus stage I–II tumours: 0.05–0.18 and 0.01–0.06 across countries) and increasing age (ORs for patients 70–79 and ≥80 versus those <60 years: 0.37–0.63 and 0.03–0.16 across countries). Patients with advanced-stage tumours (stage III–IV: 63.8%–81.2%) and at older ages (≥70 years: 52.6%–59.5%) receiving less frequently resection comprised the majority of diagnosed cases. Patient performance status, tumour location and size were also associated with resection application.Conclusion Rates of PaC resection remain low in Europe and USA with great international variations. Further studies are warranted to explore reasons for these variations.