Simple SummaryThis study highlights significant issues with access to pancreatic surgery in Italy. The distribution of adequate facilities for pancreatic surgery is inhomogeneous throughout the country, with provision decreasing from north to south. This study found that patients from Southern and Central Italy had significantly higher rates of mobility to Northern Italy for pancreatic resections compared to patients in the north. This highlights the unequal access to pancreatic surgery that exists in Italy. This study also found that mortality rates for non-migrating patients receiving surgery in Southern and Central Italy were significantly higher than for migrating patients. This indicates the need to implement adequate facilities in the southern and central regions, to reduce mortality and ensure equal access to care for all patients.AbstractPatients requiring complex treatments, such as pancreatic surgery, may need to travel long distances and spend extended periods of time away from home, particularly when healthcare provision is geographically dispersed. This raises concerns about equal access to care. Italy is administratively divided into 21 separate territories, which are heterogeneous in terms of healthcare quality, with provision generally decreasing from north to south. This study aimed to evaluate the distribution of adequate facilities for pancreatic surgery, quantify the phenomenon of long-distance mobility for pancreatic resections, and measure its effect on operative mortality. Data refer to patients undergoing pancreatic resections (in the period 2014–2016). The assessment of adequate facilities for pancreatic surgery, based on volume and outcome, confirmed the inhomogeneous distribution throughout Italy. The migration rate from Southern and Central Italy was 40.3% and 14.6%, respectively, with patients mainly directed towards high-volume centers in Northern Italy. Adjusted mortality for non-migrating patients receiving surgery in Southern and Central Italy was significantly higher than that for migrating patients. Adjusted mortality varied greatly among regions, ranging from 3.2% to 16.4%. Overall, this study highlights the urgent need to address the geographical disparities in pancreatic surgery provision in Italy and ensure equal access to care for all patients.