Background and Aims: Pancreatic ductal adenocarcinoma (PDAC) is a highly malignant digestive tumor, and the patients may face a risk of early postoperative recurrence (recurrence within postoperative 6 months) even after radical resection. Further, the perioperative risk factors for predicting early recurrence remain unclear so far. This study was designated to investigate the risk factors for early postoperative recurrence of PDAC, and the clinical value of preoperative neoadjuvant chemotherapy (NAC) and postoperative adjuvant chemotherapy (PAC) in preventing early recurrence of PDAC. 
Methods: The clinical data of 141 patients with PDAC who underwent pancreatectomy in Panjin Liao-Oil Gem Flower Hospital from January 2011 to December 2016 were retrospectively analyzed. Of the patients, 64 cases (47.5%) received NAC and 103 cases (73.0%) received PAC; recurrence occurred in 45 cases and did not occur in 96 cases within postoperative 6 months.
Results: The results of univariate analysis showed that TNM stage, preoperative CA19-9 level, NAC, postoperative complications, postoperative CA19-9 level and PAC were associated with early postoperative recurrence (all P<0.05). The results of comparative analysis among different treatment methods, the incidence of early local recurrence in patients undergoing NAC (undergoing NAC or NAC+PAC) was lower than those without NAC (undergoing pure surgery or PAC) (partial P<0.05); the incidence of early distant metastasis in patients undergoing PAC (undergoing PAC or PAC+NAC) was lower than those without PAC (undergoing pure surgery or NAC) (all P<0.05). The results of multivariate analysis showed that the advanced TNM stage (III vs. I: HR=1.866, 95% CI=1.148–3.035, P=0.012; III vs. II: HR=1.790, 95% CI=1.044–3.068, P=0.035), postoperative CA19-9 level above 37 IU/mL (HR=1.998, 95% CI=1.200–3.325, P=0.008) and absence of PAC (HR=1.962, 95% CI=1.176–3.273, P=0.010) were independent risk factors for early postoperative recurrence. 
Conclusion: TNM stage, postoperative CA19-9 level and PAC are important predictor of early recurrence of PDAC. Although PAC is an important preventive measure against the early recurrence, particularly distant metastasis of PDAC, NAC can effectively prevent the early local recurrence of PDAC. So, there is a potential complementary association between the two regimens.