Surgical Re-Resection for Isolated Local Recurrence of Pancreatic Cancer: A Case Series of 3 Patients and Literature Review.

[OBJECTIVE] This retrospective case series study aims to assess the clinical role of surgical re-resection for isolated local recurrence of pancreatic cancer, integrating detailed case presentations with current evidence to clarify patient selection criteria, operative feasibility, and oncologic outcomes.

[CASE PRESENTATIONS] We present three patients with locally recurrent pancreatic cancer who underwent repeat pancreatic resection. Patient 1, who previously underwent distal pancreatectomy for an Intraductal Papillary Mucinous Neoplasm (IPMN)-associated adenocarcinoma, developed a new pancreatic head lesion three years later and underwent pylorus-preserving pancreaticoduodenectomy; histopathology confirmed a small invasive IPMN, and the patient remains alive 8 years after the initial diagnosis and 5 years after the reoperation. Patient 2, who had previously undergone Pylorus-Preserving Pancreaticoduodenectomy for distal bile duct adenocarcinoma, developed recurrent disease in the pancreatic body and tail three years later. He underwent distal pancreatectomy but developed liver recurrence due to hematogenous metastasis one month postoperatively and succumbed 6 months later from generalized widespread disease. Patient 3, who previously underwent a Whipple procedure for IPMN-associated adenocarcinoma, developed a recurrent mass at the pancreatojejunostomy five years later and underwent distal pancreatectomy, with an uneventful recovery.

[CONCLUSION] Our findings suggest that repeat pancreatic resection may be feasible in carefully selected patients with isolated local recurrence, potentially offering a survival benefit. Strict selection criteria, including the absence of distant metastases, good performance status, and technically resectable disease, appear essential to optimize outcomes, supporting the consideration of surgical re-resection as an option within a multidisciplinary management framework.