Objective To determine the clinical characteristics and treatment outcomes of women with recurrent uterine leiomyosarcoma (uLMS). Methods We conducted a retrospective cohort study to evaluate the clinical characteristics and survival of women with recurrent uLMS and identify prognostic factors. Results Overall, 71 patients with first recurrence of uLMS were included in our study. 19 patients (26.8%) received systematic therapy and 52 patients (73.2%) received secondary cytoreductive surgery (SCS). In SCS subgroup (n=52), a complete resection with no residual disease was reported in 47 patients (90.4%). 38.5% (20/52) patients received non-genital organ surgeries. 10 (19.2%) patients had received thoracic surgery because of lung-only recurrences. Bowel, bladder surgery was performed in 8 (15.4%), 3 (5.8%) patients, respectively. 1 (1.9%) patient had received liver surgery. The median follow-up duration was 38.7 months (range: 2.7-317.6 months). 41 (57.7%) patients died during follow-up. 5-year OS for the entire cohort was 52.9%. Patients experienced first recurrence after initial diagnoses within 12 months (n=24) had a worse 5-year OS than those after 12 months (n=47) (17.0% vs 69.1%, P<0.001). 5-year OS for the SCS and non-SCS subgroup was 62.0% and 28.0%, respectively (P<0.001). Multivariate analysis showed time to fist recurrence within 12 months (HR=4.60, 95% CI: 1.49-14.4, P = 0.008) was an independent predictor of decreased 5-year OS in SCS subgroup. Conclusion SCS is an important treatment choice for recurrent uLMS and seems to have benefited patients. Time to fist recurrence within 12 months is an independent predictor of decreased 5-year OS in SCS subgroup.