Surgeons should consider local therapies for recurrent pancreatic ductal adenocarcinoma as they show significant survival benefits.

• For liver-only recurrence, local therapy leads to longer survival than chemotherapy alone (HR 0.26).
• Surgical resection for lung-only recurrence offers better survival compared to conventional treatment (HR 0.35).

Careful patient selection and tailored approaches could enhance outcomes in recurrence management.

• Locoregional resection also correlates with increased survival (HR 0.52).