Background In a proportion of patients with recurrence of gastric cancer after surgery, that recurrence is in the No. 13 lymph node group. The treatment of these patients are still controversal and challenging. Here we used a modified ‘Artery-first’ approach technique and retrospective analysis the data to examined the efficacy and feasibility of reoperative pancreaticoduodenectomy for recurrent cancer in this lymph node group after initial subtotal gastrectomy. Methods From January 2011 to December 2015, 24 patients underwent pancreaticoduodenectomy with a modified ‘Artery-first’ approach technique for recurrent gastric cancer in the No. 13 lymph node group at Tongji Hospital, Wuhan, China. Their medical records were retrospectively reviewed for relevant clinical characteristics, type of first and second surgical procedures, TNM stage, adjuvant treatments, complications, and survival. Kaplan–Meier curves were used to analyze survival. Results The median interval between the first and second operations was 7.5 (range 4.5–13.5) months and the median duration of follow-up 20.1 (range 5–58) months. The median operation time was 6.5 (range 5.0–9.9) hours, and median blood loss 448 (range 110–1200) mL. The median intensive care unit stay was 1.5 (range 1–4) days and the median postoperative hospital stay 31.6 (range 15–55) days. No patient died. Two had serious complications. The median survival after pancreaticoduodenectomy was 28 (range 5–58) months. 13 patients had subsequent recurrence. T stage, N stage, and adequacy of resection influenced survival. Conclusion s Pancreaticoduodenectomy with a modified ‘Artery-first’ approach technique is a reasonable treatment option for recurrent remnant gastric cancer following unexpanded lymphadenectomy, particularly for patients with no distant metastases. Additionally, D2+ lymphadenectomy may be more effective than D2 lymphadenectomy in patients with locally advanced gastric cancer.