Resection of pancreatic cancer in Europe and USA: an international large-scale study highlighting large variations

Lei Huang, Lina Jansen*, Yesilda Balavarca, Esther Molina-Montes, Masoud Babaei, Lydia van der Geest, Valery Lemmens, Liesbet Van Eycken, Harlinde De Schutter, Tom B Johannesen, Claus W Fristrup, Michael B Mortensen, Maja Primic-Žakelj, Vesna Zadnik, Nikolaus Becker, Thilo Hackert, Margit Mägi, Tiziana Cassetti, Romano Sassatelli, Robert GrützmannSusanne Merkel, Ana F Gonçalves, Maria J Bento, Péter Hegyi, Gábor Lakatos, Andrea Szentesi, Michel Moreau, Tony van de Velde, Annegien Broeks, Milena Sant, Pamela Minicozzi, Vincenzo Mazzaferro, Francisco X Real, Alfredo Carrato, Xavier Molero, Marc G Besselink, Núria Malats, Markus W Büchler, Petra Schrotz-King, Hermann Brenner

*Corresponding author for this work

    Research output: Contribution to journalJournal articleResearchpeer-review


    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.

    Original languageEnglish
    Issue number1
    Pages (from-to)130-139
    Publication statusPublished - 1. Jan 2019

    Bibliographical note

    © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2019. All rights reserved. No commercial use is permitted unless otherwise expressly granted.


    • TNM stage
    • age
    • pancreatic cancer
    • population-based
    • surgical resection
    • variation
    • Practice Patterns, Physicians'/statistics & numerical data
    • SEER Program
    • Europe
    • Humans
    • Middle Aged
    • Male
    • Pancreatic Neoplasms/epidemiology
    • United States/epidemiology
    • Survival Analysis
    • Aged, 80 and over
    • Adult
    • Female
    • Registries
    • Aged
    • Neoplasm Staging

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