International General Thoracic Database Collaboration.

This article examines the potential of large international registries as key tools for quality improvement, benchmarking, and clinical research, while addressing current barriers to collaboration. The European Society of Thoracic Surgery Databse (ESTS) and The Society of Thoracic Surgery General Thoracic Database are the leading platforms, with the ESTS serving as a truly multinational repository supported by both individual units and national registries. The Hungarian and Brazilian models are examples of successful integration within the ESTS framework. Major challenges for successful collaboration include internal structural agreement, updating of content, legal constraints, and sustainability.