Liver metastasis surgery followed by radical treatment for pancreatic ductal adenocarcinoma: A case report

The prognosis of patients with pancreatic ductal adenocarcinoma (PDAC) with liver metastasis is poor; therefore, chemotherapy is often selected instead of surgical intervention. However, there are some reports of cases becoming resectable after multidisciplinary treatment. On the other hand, there have been a few cases of long-term survival in which liver metastases were resected first, followed by prolonged chemotherapy and subsequent resection of the primary tumor. The present study describes the case of a patient with PDAC in which a liver metastasis was resected first, followed by chemotherapy and subsequent resection of the primary tumor, resulting in long-term survival. Briefly, a 72-year-old man diagnosed with resectable PDAC was scheduled to undergo subtotal stomach-preserving pancreaticoduodenectomy after neoadjuvant chemotherapy. Intraoperatively, a liver metastasis was detected, and partial hepatectomy was performed. The patient received 13 cycles of modified 5-fluorouracil, leucovorin, irinotecan and oxaliplatin. A subtotal stomach-preserving pancreaticoduodenectomy was then performed when no new lesions were observed. The patient received S-1 as adjuvant chemotherapy for 1 year postoperatively. Currently, 5 years after diagnosis, and 4 years and 3 months after the last surgery, the patient has experienced no recurrence. In conclusion, even if curative surgery is not possible because of a liver metastasis at the time of the initial operation, some patients may achieve long-term survival through resection, and preoperative and postoperative chemotherapy.