[Successful Resection of a Metachronous Liver Metastasis after Pancreatic Ductal Adenocarcinoma Surgery-A Case with...

The patient was a 72-year-old woman who had previously undergone pylorus-preserving pancreaticoduodenectomy for pancreatic ductal adenocarcinoma(PDAC), followed by 1 year of adjuvant chemotherapy with S-1. Forty-eight months after surgery, imaging revealed a solitary tumor in liver S6. PET-CT showed no other metastatic sites, and liver biopsy confirmed adenocarcinoma consistent with pancreatic origin, leading to the diagnosis of metachronous liver metastasis. An extended subsegmentectomy of S6 was performed, and pathology revealed liver metastasis with infiltration into the right hepatic vein but negative surgical margins(R0). Postoperatively, the patient received an additional year of S-1 chemotherapy. At 2 years after hepatectomy, the patient remains recurrence-free under regular outpatient follow-up. Although current PDAC guidelines do not recommend liver resection for metastatic disease due to its typically poor prognosis, recent case reports suggest that surgical intervention may benefit selected patients with solitary liver metastases and a long disease-free interval. This case highlights the potential role of liver resection in carefully chosen patients with oligo-recurrence after PDAC surgery. Accumulation of similar cases and further evaluation of long-term outcomes are necessary to better establish treatment strategies for metachronous liver metastases in PDAC.