Background: Multiple randomized controlled trials (RCTs) have established several systemic therapy regimens as adjuvant therapy treatment options for resected pancreatic cancer, including modified FOLFRINOX (mFFX), gemcitabine and capecitabine (GemCap) and S1, mostly based on comparison with gemcitabine (Gem) alone. Many of these regimens have not been directly compared in RCTs and their relative survival benefits are unknown. Methods: A systematic review was conducted using MEDLINE, EMBASE, Cochrane Central and ASCO abstracts to identify phase III RCTs up to June 2018 that examined adjuvant systemic therapy in resected pancreatic cancer. Two reviewers independently reviewed the studies and discrepancies were resolved either by discussion or by a third reviewer. Data including study characteristics and outcomes including overall survival (OS) and disease-free survival (DFS) were extracted. Indirect comparisons of all regimens were simultaneously compared using random-effects network meta-analyses (NMA) (R package “netmeta”) which maintains randomization within trials. Results: Nine phase III RCTs involving 3,394 patients and 6 regimens (5-flourouracil and folinic acid, Gem, gemcitabine and erlotinib (GemErl), GemCap, mFFX and S1) were identified. Hazard ratios (HR) and 95% confidence intervals (CI) of OS and DFS of selected comparisons from the results of the NMA are shown in the table. Conclusions: Both mFFX and S1 appeared to be superior to GemCap and can be considered as reasonable standard treatment options for suitable patients and as control arm regimens of future adjuvant clinical trials.