Background : The effectiveness of surgical re-resection for locally recurrent pancreatic ductal adenocarcinoma (PDAC) in the remnant pancreas after curative resection has not yet established. This study aimed to evaluate the efficacy of repeat pancreatectomy compared to systemic chemotherapy for local recurrence only in the remnant pancreas with two institutional database.

Methods : From January 2010 to July 2022, a retrospective bi-institutional study included 21 patients who underwent re-resection (group 1) and 23 patients who received only chemotherapy without surgical treatment (group 2) for solitary recurrent tumor in the remnant pancreas without systemic metastasis. Oncologic long-term outcomes were analyzed using Kaplan-Meier method between two groups.

Results : Baseline and tumor-related factors were similar between the two groups. The time to recurrence in the remnant pancreas and overall survival were significantly longer in Group 1 (25.7 vs. 12.5 months, P= 0.008; 44.0 vs. 25.0 months, p=0.011, respectively). However, there were no significant differences in median survival after recurrence between the two groups (20.9 vs. 11.4 months, P= 0.518). When the survival rates were compared by dividing the time until recurrence within and after one year, there was no difference in the overall survival rate after recurrence between the two groups.

Conclusions : Although in cases of resectable isolated local recurrent tumor in remnant pancreas after curative resection for PDAC, re-resection does not provide additional long-term oncologic benefits compared to systemic chemotherapy. It appears reasonable to treat recurrent PDAC in the remnant pancreas similarly to systemic recurrence with chemotherapy.