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

TL;DR

A patient with pancreatic cancer survived over 8 years after multiple liver surgeries and chemotherapy for recurring metastases.

Contribution

This case highlights the potential of multidisciplinary treatment in extending survival for PDAC with liver metastases.

Findings

The patient underwent three liver resections and RFA over 8 years.

Combination therapy included chemotherapy and surgical interventions.

The patient remains disease-free more than 8 years post-initial surgery.

Abstract

Recurrence of pancreatic ductal adenocarcinoma (PDAC) after primary resection remains a challenging condition, and operative indications for metachronous liver metastases are limited.

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.

Multidisciplinary treatment, including chemotherapy, resection, and RFA, may increase survival time in selected PDAC patients.

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