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Disease recurrence after resection of pancreatic ductal adenocarcinoma (PDAC) remains one of the most significant challenges in managing PDAC. Despite optimal treatment combining tumor resection and systemic therapy, nearly all patients experience PDAC recurrence following surgery.

This thesis explores advancements in diagnosing, treating, and improving survival outcomes for PDAC recurrence through a multidisciplinary approach. First, alternative randomized trial designs are introduced and evaluated in the context of surgical research. Next, Part I covers the surgical perspective, investigating the application of surveillance strategies and routine diagnostics after resection of PDAC. Part II shifts to the oncological perspective, discussing the prediction and management of PDAC recurrence. Finally, Part III focuses on the radiotherapeutic perspective, highlighting the role of stereotactic body radiotherapy (SBRT) for managing isolated local recurrences.