Jones RP, Psarelli EE, Jackson R, et al. - In this secondary analysis of a randomized clinical trial, researchers focused on the patterns of disease recurrence following resection of pancreatic cancer followed by systemic chemotherapy, as well as the link with survival. From an international multicenter study—the phase 3 European Study Group for Pancreatic Cancer 4 adjuvant clinical trial— prospectively gathered data were studied. A total of 730 patients were included who were randomized to adjuvant gemcitabine or gemcitabine plus capecitabine. Findings revealed no significant variations between the time to recurrence and subsequent and overall survival between local and distant recurrence. Reduced rate of local recurrence and improved overall survival were achieved with adjuvant gemcitabine plus capecitabine vs gemcitabine monotherapy. Experts concluded that pancreatic cancer behaves as a systemic disease needing effective systemic therapy following resection.