Local Recurrence After Pancreatic Cancer Resection: A Multidisciplinary Review of Risk Factors and Potential Causes,...

Pancreatic cancer represents a malignant tumor of the digestive system with an inferior clinical prognosis, primarily attributable to the challenges in early diagnosis that preclude surgery-based treatment for most patients. Furthermore, the high postoperative recurrence rate significantly limits long-term survival in surgical candidates. Among patients experiencing recurrence after pancreatic cancer resection, local recurrence emerges as one of the most prevalent patterns. Early detection remains equally critical for recurrent cases, as selected patients undergoing potentially curative therapy for localized recurrence demonstrate that they can still extend post-recurrence survival. This comprehensive review synthesizes current evidence regarding the pathogenesis, risk determinants, diagnostic approaches, therapeutic interventions, and preventive measures for local recurrence following pancreatic cancer surgery. Emphasis is placed on analyzing the potential etiopathogenetic mechanisms and risk determinants for postoperative local recurrence, including tumor biology characteristics, tumor microenvironment interactions, and clinicopathological influences, providing foundations for preventive strategies. Emerging diagnostic modalities, particularly advanced imaging, and histopathological techniques, enhance early detection of locoregional recurrence. The review further examines evolving treatment paradigms encompassing precision radiotherapy, targeted systemic therapies, and innovative immunotherapeutic approaches for recurrent disease management. By integrating multidisciplinary perspectives, this work aims to inform optimized preventive approaches, surveillance and diagnostic protocols, and advance personalized management strategies for postoperative local recurrence in patients with pancreatic cancer.