An 8-Year Survivor after Three-Time Hepatectomies for Metachronous Pancreatic Adenocarcinoma Liver Metastases

INTRODUCTION: Recurrence of pancreatic ductal adenocarcinoma (PDAC) after primary resection remains a challenging condition, and operative indications for metachronous liver metastases are limited. CASE PRESENTATION: A 60-year-old woman with no elevation of carcinoembryonic antigen, carbohydrate antigen 19-9, and Duke pancreatic monoclonal antigen type 2 underwent a distal pancreatectomy for PDAC. Two years and 4 months after the primary surgery, metachronous liver metastases in liver segments 4 and 5 were diagnosed. After receiving 8 courses of bi-weekly gemcitabine plus nab-paclitaxel, a partial liver resection of segment 5 with radiofrequency ablation (RFA) of segment 4 was performed. A laparoscopic partial liver resection of segment 8 was performed for another liver metastasis 5 years and 2 months after the primary resection. An open partial liver resection of segment 8 was performed for the liver recurrence adjacent to the previous resection area 7 years and 2 months after the initial pancreatectomy. More than 8 years have passed since the initial pancreatic surgery, and she is currently alive without disease. CONCLUSION: Multidisciplinary treatment, including chemotherapy, resection, and RFA, may increase survival time in selected PDAC patients.