Background: Recurrence rates after resection of pancreatic ductal adenocarcinoma (PDA) can be up to 80%. Prior data suggests that initial site of recurrence influences prognosis. This study aims to compare survival of patients (pts) with resected PDA by initial site of recurrence. Methods: We retrospectively reviewed the demographics, treatments, recurrence and survival of 717 pts with PDA who underwent resection at Columbia University Irving Medical Center from 2011 to 2020 and were part of a tumor registry. Analyses were performed using Kaplan-Meier and paired T-tests. Results: Of 717 pts with resected PDA, 320 had confirmed recurrence. Median age at diagnosis was 67 years (yrs). Among pts with a single initial recurrence site, 36 recurred in lung, 97 in liver, 95 locally, and 23 in peritoneum. 58 pts had initial recurrence at 2 or more sites. Neoadjuvant treatment had been administered in 42%, 36%, 40%, 35%, and 22% of pts with lung, liver, local, peritoneal, and multiple sites at initial recurrence, respectively (p=0.21). Adjuvant treatment had been administered in 72%, 69%, 76%, 70%, and 72% of pts with lung, liver, local, peritoneal, and multiple sites at initial recurrence, respectively (p=0.88). Pts with initial lung recurrence had a significantly longer median overall survival (mOS), 4.39 yrs, compared to initial recurrence in the liver (1.98 yrs, p=0.02), peritoneum (2.19 yrs, p=0.0002), and at multiple sites (2.66 yrs, p=0.03). A significantly longer time from diagnosis to recurrence was observed in pts who had initial lung recurrence, compared to pts who had initial hepatic, peritoneal or multiple site recurrences. Pts with initial lung recurrence had a significantly longer time from first recurrence to death compared to pts with initial peritoneal recurrence. See Table for summary. Conclusions: Pts with resected PDA with initial pulmonary recurrence experience improved survival compared to those who recur at other distinct or multiple sites. The underlying pathways contributing to this improved survival need to be investigated further.

p-values are for comparisons with lung-only recurrence