Background: Although recurrence is common after curative resection of pancreatic ductal adenocarcinoma (PDAC), little is known regarding the pattern of recurrence. Methods: We reviewed clinical data of 1,138 consecutive patients with PDAC who underwent pancreatectomy from 2000 to 2010 to document the pattern of recurrence based on CT and/or MRI and/or FDG-PET scan. Local recurrence (LR) was defined as cancer recurrence at the pancreatectomy site. Recurrence in the omentum, peritoneum, liver, lung, spine, pelvic or supraclavicular lymph nodes was considered as distal recurrence (DR). Results: The median follow up was 17 months (IQR 26 months). Of 845 patients with complete follow-up, 470 (55.6%) had recurrence with the following pattern: LR only in 111 (23.6%), liver recurrence only in 128 (27.2%), lung recurrence only in 55 (11.7%), local and DR in 84 (17.9%), and other recurrences in 92 (19.6%). 405 (86.2%) patients had only intra-abdominal recurrence. In the patients who recurred, 49.8% and 80.2% recurred within 1 year and 2 years from the resection respectively. The incidence of recurrence at different time after pancreatectomy was summarized in the Table. More patients with liver only recurrence occurred within 6 months after resection comparing to that with LR only (41% vs 9%, p<0.001). The median overall survival (OS) of the entire cohort is 22.6 month and varied significantly based on recurrence pattern (Table). The median OS of patients with lung only recurrence is longer than that with liver only recurrence (31.6 vs 16.7 months, p<0.001). Conclusions: The pattern of recurrence is associated with distinct survival and supports the observation that PDAC is genetically diverse. Our findings are important in selecting patients for personalized treatment combinations and laying the groundwork for defining the molecular basis behind the biological diversity of PDAC.