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Background: Recurrence of pancreatic cancer after primary pancreatectomy occurs in the vast majority of patients. The role of surgical treatment for recurrent pancreatic cancer is not well established. Methods: Patients who underwent primary pancreatectomy with curative intent from 2000 to 2014 at a single large-volume centre were evaluated retrospectively. CT or PET was used to select patients with an isolated recurrence. The clinicopathological features and survival outcomes were compared according to treatment modalities. Results: Of the 1610 patients with pancreatic cancer who underwent resection, 1346 (83⋅6 per cent) were diagnosed with recurrent pancreatic cancer. Recurrence was locoregional in 366 patients (27⋅2 per cent), distant multifocal in 251 (18⋅6 per cent), distant isolated in 188 (14⋅0 per cent), locoregional plus distant in 153 (11⋅4 per cent) and peritoneal seeding in 388 (28⋅8 per cent). Of the 1346 patients with recurrence, 197 (14⋅6 per cent) had isolated recurrence; of these, 48 (24⋅4 per cent of all isolated recurrences; 3⋅6 per cent of all recurrences) underwent resection. Median survival of the 197 patients after diagnosis of isolated recurrence was 14⋅7 months; it was longer in patients who underwent surgical resection than among those treated non-surgically (23⋅5 versus 12⋅0 months; P = 0⋅014). Multivariable analysis showed that chemotherapy and resection for recurrence were associated with better prognosis. Median survival after recurrence was longest in the 23 patients with isolated pulmonary recurrence (33⋅3 months). Survival after recurrence was better in patients who underwent resection of isolated recurrence in the remnant pancreas (median 28⋅0 versus 12⋅0 months, P = 0⋅010) and lung (median 36⋅5 versus 9⋅5 months; P = 0⋅010) than in those who did not undergo resection.Conclusion: Surgical resection may be considered an option for treatment of patients with isolated recurrent pancreatic cancer.

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